Medical Claims Examiner

16 hours ago

Colorado Springs, Colorado, United States USAA Full time
Job Summary

We are seeking a highly skilled Medical Claims Adjuster to join our team at USAA. As a Medical Claims Adjuster, you will be responsible for adjusting attorney-involved moderately complex bodily injury and UM claims, as well as catastrophic auto PIP/MP medical claims.

Key Responsibilities
  • Identify and manage existing and emerging risks associated with business activities
  • Ensure risks are effectively identified, measured, monitored, and controlled
  • Adjust attorney-involved moderately complex bodily injury claims with demonstrable injuries and UM claims, as well as all auto physical damage associated with those claims
  • Adjust catastrophic 1st party PIP/MP medical claims
  • Investigate loss details, determine legal liability, evaluate, negotiate, and arrive at claim settlement within appropriate authority guidelines
  • Clearly document thought process, investigation, evaluation, negotiation, and settlement decisions
  • Prioritize and manage assigned claims workload to keep members and other involved parties informed, provides timely claims status updates
Requirements
  • Deep knowledge and understanding of the auto claims contract as well as application of case law and state laws and regulations
  • Acquisition and maintenance of insurance adjuster license within 90 days and designated number of attempts
  • 1yr Medical experience to include coding and billing or EMT
  • Ongoing Professional Development with a focus on Insurance
  • Bachelors degree or higher
  • US military experience through military service or a military spouse/domestic partner
What We Offer

USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. Employees may be eligible for pay incentives based on overall corporate and individual performance or at the discretion of the USAA Board of Directors. Shift premium will be addressed on an individual-basis for applicable roles that are consistently scheduled for non-core hours.

At USAA, our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs.

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