What are the responsibilities and job description for the Claims Specialist - MedPay position at American National?
Are you looking for the next step in your insurance career? American National is hiring a Claims Specialist in our MedPay/PIP division. You will represent the American National property and casualty auto claims division, as you elevate the client experience and adjust moderate to more complex level MedPay and personal injury protection (PIP) auto claims. To thrive in this role, you must have strong customer service skills, enjoy investigation, research, follow-up, and providing support to others in their time of need. You should also have the ability to use available resources and be an analytical thinker.
What You'll Do
- Promptly adjust personal and commercial lines MedPay/PIP auto claims across the U.S. while adhering to company best practices and state and federal statutes and regulations
- Complete thorough coverage investigations, assess/apply the appropriate order of priority, send reservations of rights, and coverage disclaimers when appropriate
- Communicate directly with injured parties and/or their attorneys and medical providers on coverage, treatment, and payment status
- Obtain and review necessary medical documentation to set appropriate reserves and subsequently monitor for accuracy
- Identify potential fraud indicators and subrogation opportunities throughout the life cycle of the file.
- Review and recognize complex issues that require presentation to management, in-house counsel, defense counsel, and internal committee
- Navigate PIP arbitrations via phone and email
- Provide backup assistance to team members when necessary
- Complete ongoing continuing education to maintain active adjuster license(s)
- Review and interpret medical bills and records as they relate to auto accidents
- Maintain compliance by addressing medical bills timely and accurately
- Navigate vendor computer program to pay medical bills on a daily basis
- Maintain Medicare compliance
- Identify UM/UIM potential
What You'll Need
- Auto claims adjusting and/or relevant work experience considered: (Medical, Legal, Insurance, Law enforcement, Customer Service background(s)
- Currently hold an appropriate state adjuster license or obtain following date of hire (American National will incur fees associated / No out of pocket expenses)
- Ability to prioritize, work independently, and make sound decisions
- Ability to be analytical when reviewing details and documents
What Will Set You Apart
- Four-year degree in relevant field
- Understanding of statutes, case laws, and policy contracts
- Experience with Mitchell & Guidewire preferred, or similar billing and claims management systems
