USA

Medical Payment Auto Claims Adjuster

Birmingham - Alabama (AL), 35209

Allstate

Estimated salary $42,200 a year

Job Description:

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Job Description

Allstate Insurance Company has an exceptional career opportunity for a Medical Payment Claims Adjuster located in Birmingham, AL!


The Medical Payment Adjuster is responsible for handling the medical portion of auto accident claims for the insured or other injured parties found to be eligible under personal injury protection and/or medical payment benefits where the policy limits or exposure to the company is limited. This individual determines coverage and assesses medical claims, evaluates medical bills and initiates or reviews potential fraud investigations as warranted. The individual explains coverage, negotiates and settles claims and follows up with the customer on continuing treatments while gaining experience in delivering compassionate service that is fast, fair, and easy, to ensure customer retention. At this level, the individual typically settles minor or smaller claims, such as claims in less regulated states (or on some occasions more complex claims with guidance as needed). The individual is gaining experience in delivering compassionate service that is fast, fair, and easy, to ensure customer retention. The individual is capable of working independently, prioritizing the individual's own responsibilities, and managing the individual's own workload.


Key Responsibilities

Customer Service


  • Makes and maintains a connection with the customer by understanding and meeting their needs; serves the customer with empathy; and follows up to ensure that customer needs have been met


File Documentation and Reporting


  • Summarizes documents and enters into claim system notes
  • 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 in determining reasonableness of charges and relation of injuries to accident, and to ensure compliance with fee schedules, and detect duplicate billing
  • Conducts first party file processing/fact gathering, including interviewing claimant, witnesses, medical providers, etc.
  • Evaluates medical records and treatment plan of claimant and determines if continued treatment is reasonable
  • Investigates, reviews and accepts or rejects coverage and other potential coverage
  • Determines appropriate benefit and settles basic claims, including resolution of basic usual and customary billings
  • Monitors treatment and benefit payments for excessive, unreasonable, or abusive claims


Compensation and other important information:


  • Starting salary: $42,200 annually (paid bi-weekly)
  • Must be available to work a scheduled shift Monday - Friday between the hours of 7:00am - 7:30pm with occasional Saturday


Notice of Licensing Requirement


As a condition of your employment, you may be expected to comply with the state specific licensing process and requirements to perform work as a Medical Payment Adjuster. Failure to complete these requirements within the time frame designated by the hiring department may result in the termination of your employment with Allstate Insurance

Company.


Job Qualifications

  • Bachelors degree, prior adjusting/insurance experience, or medical billinng and coding experience preferred
  • At least 2 years of customer service experience in an office environment
  • Experienced with handling heavy call volume
  • Interact effectively with internal or external customers and act with empathy
  • Ability to investigate, evaluate, negotiate and settle basic claims
  • Knowledge of claim processes, policies, procedures, claim systems, coverage, liability, damage estimating, and/or settlement, and adherence to applicable legal compliance standards
  • Ability to apply industry knowledge to discipline practices, including best practices, to support the business unit
  • Ability to leverage learned technical skills in support of team objectives
  • Conflict management and problem resolution skills in managing internal and external customer relationships
  • Provides individual decision making within authority limits
  • Bilingual candidates strongly encouraged to apply
  • Prior Military are encouraged to apply
  • Has and maintains all appropriate licenses and registrations for the role per state requirements


Regular, predictable attendance is an essential function of this job.


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.


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To view the “EEO is the Law” poster click “here”. This poster provides information concerning the laws and procedures for filing complaints of violations of the laws with the Office of Federal Contract Compliance Programs


To view the FMLA poster, click “here”. This poster summarizing the major provisions of the Family and Medical Leave Act (FMLA) and telling employees how to file a complaint.


It is the Company’s policy to employ the best qualified individuals available for all jobs. Therefore, any discriminatory action taken on account of an employee’s ancestry, age, color, disability, genetic information, gender, gender identity, gender expression, sexual and reproductive health decision, marital status, medical condition, military or veteran status, national origin, race (include traits historically associated with race, including, but not limited to, hair texture and protective hairstyles), religion (including religious dress), sex, or sexual orientation that adversely affects an employee's terms or conditions of employment is prohibited. This policy applies to all aspects of the employment relationship, including, but not limited to, hiring, training, salary administration, promotion, job assignment, benefits, discipline, and separation of employment.

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