Personal Injury Protection Adjuster

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

📋 Description

• Manage the medical aspect of auto accident claims for insured individuals or eligible injured parties under personal injury protection and/or medical payment benefits.

• Assess coverage and evaluate medical claims.

• Review medical bills and initiate or oversee potential fraud investigations.

• Clarify coverage details, negotiate, and finalize claims settlements.

• Maintain follow-up with customers regarding ongoing treatments while providing compassionate service.

• Negotiate and conclude moderately complex claims.

• Work autonomously, prioritize tasks, and manage workload efficiently.

• Foster customer relationships, comprehend and fulfill customer needs, and follow up on service inquiries.

• Investigate and address moderately complex customer communications, concerns, conflicts, or issues.

• Summarize documents and input notes into the claims system.

• Record claim files with notes, evaluations, and decision-making processes.

• Process medical bills and identify opportunities for medical management.

• Evaluate claimants’ medical/physical conditions and prior injuries.

• Analyze medical bills, wage loss assessments, home service or attendant care, mileage reimbursements, and related claims.

• Conduct first-party file processing and fact gathering, including interviews with claimants, witnesses, and medical providers.

• Review medical records and treatment plans to determine the reasonableness of ongoing treatment.

• Organize Independent Medical Examinations (IMEs) and review their outcomes.

• Investigate, examine, and accept or deny moderately complex coverage and potential coverage issues.

• Determine suitable benefits and resolve standard and customary billing queries.

• Monitor treatment and benefit payments for excessive, unreasonable, or fraudulent claims.

• Manage specialized claims.

• Engage in moderately complex special projects.

• Act as a committee team lead or team member on various projects.

• Review subpoenas and non-complex demands.

• Advocate for agents.

• Prepare and negotiate moderately complex subrogation matters or arbitrations.

⛳️ Requirements

• In-depth knowledge of insurance policies, especially personal injury protection coverage and associated regulations.

• Capability to evaluate claims by analyzing accident reports, medical records, and other relevant documents.

• Exceptional communication skills for engaging with claimants, medical providers, and other stakeholders.

• Strong investigative and research abilities.

• Proficient analytical and critical thinking skills.

• Skilled in negotiation.

• Effective time management and organizational abilities.

• Commitment to delivering outstanding customer service, empathy, and professionalism.

• Basic understanding of applicable laws and regulations related to insurance and personal injury cases.

• Selected candidates will be aligned with an Eastern Time Zone schedule, working Monday-Friday between 8am-5pm EST.

• Must pass a background investigation.

• A dedicated, private workspace free from distractions, with suitable desk and seating is required.

• Reliable internet connection is necessary, with minimum speeds of 50 MB download and 5 MB upload.

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

🏝️ Benefits

• Competitive salary with support for ongoing development and career progression.

• Flexible scheduling options.

• Time off policy that promotes work/life balance.

• Initial and continuous training provided.

• 401K/pension plan available.

• Education reimbursement opportunities.

• Programs designed to help balance work with personal life.

• Comprehensive technology setup, including a laptop, monitors, headset, keyboard, and mouse.

• Monthly connectivity reimbursement to help cover internet expenses.