What to Expect In this role you will be investigating, confirming, paying or denying and resolving claims involving first and third party medical payments coverage or PIP that involve moderate to severe complexity. This person will also be providing outstanding customer service and have the ability to handle a large volume of claims.
What You’ll Do - 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
What You’ll Bring - 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