Claims Associate Adjuster – PIP

This is a fully remote position, open to applicants in Michigan.

📋 Description

• Deliver high-quality support to adjusters throughout the entire claims process.

• Address inquiries from policyholders, claimants, injured individuals, medical providers, and other relevant parties.

• Collect and verify any missing or incomplete information to facilitate accurate claim processing.

• Prepare and submit necessary state filings, closing documents, and administrative requests.

• Draft and disseminate correspondence in line with company standards and regulatory requirements.

• Input data into the claims management system while ensuring thorough and precise claim records.

• Coordinate with external vendors, such as appraisers, attorneys, and contractors.

• Review and process payments and invoices according to company policies and adjuster guidance.

• Provide medical providers with billing instructions, explanation of benefits (EOBs), and payment details.

• Clarify coding and documentation denials, as well as the processes for reconsideration.

• Assist with reimbursement collection from the MCCA for claims that exceed retention limits.

• Acquire HIPAA forms and request medical records for claim files.

• Manage incoming calls and mail for the claims department.

⛳️ Requirements

• Associate's degree or a suitable combination of education and experience.

• Preferred: Registered Health Information Technician (RHIT) certification.

• At least 1 year of experience in a healthcare environment, insurance, or claims is preferred.

• Required knowledge of medical terminology, HIPAA compliance, medical billing (EOBs, HICFA, CMS 1500, and small business forms), and coding practices.

• Ability to secure necessary state licensing as mandated.

• Required proficiency in Microsoft Office Suite, particularly Excel.

• Familiarity with claims management software is a plus.

• Proven ability to foster positive relationships and partnerships within the department, across the organization, and with external clients.

• Excellent verbal and written communication abilities.

• Capability to organize and prioritize tasks to meet deadlines effectively.

• Strong critical thinking skills and the ability to investigate tasks independently.

• High accuracy in data entry with strong attention to detail.

🏝️ Benefits

• Competitive base salary.

• Incentive pay based on performance.

• Comprehensive health and welfare benefits.

• 401(k) savings plan featuring profit sharing.

• Generous paid time off programs.

• Flexible work arrangements.

• Opportunities for professional development.

• A collaborative and rewarding work environment.