דרושים Personal Injury Protection Medical Pay Claims Representative ב-Tesla ב-United States, Draper

• Analyze, review, and interpret policies to assess coverage
• Handle complex to highly complex Medpay/PIP files inclusive of 3rd party claimants
• Review and process reimbursement requests under the applicable 1st party medical coverage based on fee schedules, policy terms limits and reasonable or customary charges
• Analyze file documentation, medical bills, medical records, employment, wage information and other documentation provided
• Responds promptly to written or verbal inquiries from injured parties, medical providers, and attorneys

• Comprehensive knowledge of medical terminology, CPT and ICD 10 codes
• 3+ years’ experience handling Medpay and/or PIP claims, including understanding and interpreting auto policies
• Superior knowledge of and adherence to the state laws and regulations governing the handling of auto Medpay/PIP claims
• State adjuster’s license where domiciled or obtained within 90 day of start date
• Exceptional organization skills while moving from task to task in a high pace environment

• Analyze, review, and interpret policies to assess coverage
• Handle moderate to highly complex mostly attorney represented BI claims, with some unrepresented UIMBI/UMBI claims
• Daily contact with insureds and/or claimants and/or attorney and/or vendors
• Investigate liability on claims by taking statements, reviewing police reports and talking to witnesses
• Execute on reviewing, evaluating and negotiating injury claims

• Medical terminology and medical bill experience
• Auto accident investigation experience
• 1+ years experience handling BI/UMBI/UIMBI, including understanding and interpreting auto policies
• Comprehensive knowledge of and adherence to the state laws and regulations governing the handling of auto BI/UMBI/UIMBI claims
• State adjuster’s license where domiciled or obtained within 90 day of start date
• Non-resident adjuster’s license where required in the states where we do business
• Exceptional organization skills while moving from task to task in a high pace environment

We are looking for an experienced Claims Processor who has the ability to communicate compassionately and effectively to resolve insurance claims. You’ll be responsible for working in partnership with internal teams to resolve claims, assigning claims to appropriate adjusters and handling payments and processing responsibilities as needed. In addition, you’ll work with customers, agents, and repair facilities via phone, email and text as the needs dictate. You’ll also help with pending claims management, sending regulatory letters and issuing payments.

• Reviews and determines payment of minor, undisputed and/or limited authorization claims. Assigns all other claims to appropriate adjuster
• Verifies coverage and damage reports received from vendors and customers for accuracy and consistency with the claim as reported
• Audits bills for detection of possible fraud; refers findings to management for referral to Special Investigations Unit as advised
• Prepares and submits administrative reports as required
• Provides support for unit claims associates and managers
• Deliver outstanding customer service to all internal, external, current, and prospective nationwide customers

• 3+ years directly related work experience in financial and insurance claims processing
• Onsite presence is required every day