PIP Adjuster

Description :

Where good people build rewarding careers.

Think that working in the insurance field can't be exciting, rewarding and challenging? Think again. You'll help us reinvent protection and retirement to improve customers' lives. We'll help you make an impact with our training and mentoring offerings. Here, you'll have the opportunity to expand and apply your skills in ways you never thought possible. And you'll have fun doing it. Join a company of individuals with hopes, plans and passions, all using and developing our talents for good, at work and in life.

Job Description

Allstate Insurance Company has an exceptional career opportunity for an Experienced Inside PIP Adjuster in Farmington Hills, MI!

About the Team

The Claims Department is here to restore peoples' lives after the unexpected has happened. We work to deliver compassionate service that is fast, fair and easy. Putting our customers first to resolve their claim and taking the stress out of the situation is our goal.

About the Position

Under limited supervision, this job is responsible for handling the medical portion of auto accident claims for the insured or other injured parties found to be eligible under a personal injury protection and/or medical payment benefits where the policy limits or exposure to the company is moderate or occasionally significant. This individual determines coverage and assesses medical claims, evaluates medical bills, and initiates or reviews potential fraud investigations as warranted.

Specific responsibilities include

Customer Service

  • Researches and responds to complex customer communications, concerns, conflicts or issues
  • Reviews customer satisfaction results; participates in determining necessary personal and business unit action plans

File Documentation and Reporting

  • Documents a claim file with notes, evaluations and decision making process
  • Processes medical bills and recognizes medical management opportunities

Medical Management (1st Party)

  • Assesses medical/physical condition and prior injuries of claimant, and obtains and analyzes medical bills, wage loss reviews, home service or attendant care, mileage payments, and other related claims to determine reasonableness of charges and relation of injuries to accident, and to ensure compliance with fee schedules, and detect duplicate billing
  • Evaluates medical records and treatment plan of claimant and determines if continued treatment is reasonable
  • Investigates, reviews, and accepts or rejects complex coverage and other potential coverage; and investigates coverage denial questions
  • Determines appropriate benefit and negotiates and settles complex claims, including resolution of complex usual and customary billings
  • Monitors treatment and benefit payments for excessive, unreasonable, or abusive claims
  • Reviews and responds to pre-suit demand letters; analyzes claim and demand, and recommends whether settlement is warranted or claim should be referred to legal counsel
  • May prepare for and attend (to testify at) depositions, hearings, trials, arbitrations, or mediations

Other Projects and Responsibilities

  • May serve as a committee team lead for medium-sized projects or as a committee team member on large projects
  • Reviews subpoenas and other documents related to complex litigation demands and prepares response
  • May serve as a subrogation or arbitration panelist
  • May serve as an agent advocate
  • May assist or participate in Telephone Alert Conferences regarding complex claims referred to Home Office
  • May provide back up assistance to a team leader

Job Qualifications

Ideal Qualifications

  • High School/GED degree required &/or Bachelors degree in related field preferred or equivalent experience
  • 5 - 10+ years of prior PIP claims handling experience strongly preferred
  • Ability to investigate, evaluate, negotiate and settle moderate and occasionally complex claims
  • Excellent written and verbal communication skills with a passion for helping others.
  • Strong organizational and computer skills.
  • Persistence and the ability to work through and solve problems.
  • Bilingual candidates are strongly encouraged to apply
  • Has and maintains all appropriate licenses and registrations for the role per state requirements

The candidate(s) offered this position will be required to submit to a background investigation, which includes a drug screen.

Good Work. Good Life. Good Hands®.

As a Fortune 100 company and industry leader, we provide a competitive salary – but that's just the beginning. Our Total Rewards package also offers benefits like tuition assistance, medical and dental insurance, as well as a robust pension and 401(k). Plus, you'll have access to a wide variety of programs to help you balance your work and personal life -- including a generous paid time off policy.

Learn more about life at Allstate. Connect with us on Twitter, Facebook, Instagram and LinkedIn or watch a video.

Allstate generally does not sponsor individuals for employment-based visas for this position.

Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, it is against public policy of the State of Indiana and a discriminatory practice for an employer to discriminate against a prospective employee on the basis of status as a veteran by refusing to employ an applicant on the basis that they are a veteran of the armed forces of the United States, a member of the Indiana National Guard or a member of a reserve component.

For jobs in San Francisco, please see the notice regarding the San Francisco Fair Chance Ordinance.

For jobs in Los Angeles, please seethe notice regarding the Los Angeles Ordinance.

It is the policy of Allstate to employ the best qualified individuals available for all jobs without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity/gender expression, disability, and citizenship status as a veteran with a disability or veteran of the Vietnam Era.

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