PIP Specialist

Location(s)

Lake Mary, Florida

Details

Kemper is one of the nation’s leading specialized insurers. Our success is a direct reflection of the talented and diverse people who make a positive difference in the lives of our customers every day. We believe a high-performing culture, valuable opportunities for personal development and professional challenge, and a healthy work-life balance can be highly motivating and productive. Kemper’s products and services are making a real difference to our customers, who have unique and evolving needs. By joining our team, you are helping to provide an experience to our stakeholders that delivers on our promises.

Thoroughly investigates processes and equitably settles first party PIP / Medpay claims. Ensures that all assigned claims are concluded promptly, equitably and economically within pre-established standards and within the provisions of the insurance policy affording coverage for the loss.

Job Responsibilities :

Medical Claims Handling : Identify involved parties eligible for coverage, analyze medical bill, lost wage and other expense claims submitted for payment using a consistent and thorough review process. Develop and maintain rapport with the claimant or claimant’s representative. Establish accurate loss and expense reserves relative to the damages assessed. Research and interpret injury related statutory provisions and case law. Identifies Medicare eligible parties. Examine points of impact and extent of damage relative to the injury claimed. Access prior injury information as it relates to the automobile accident. Obtain proper medical reports, medical bills, wage and other expense information. Conduct detailed research relating to damages submitted for payment. Obtain proper release information when applicable. Utilize IME and Peer Review processes when appropriate. Apply applicable offsets when appropriate. Thoroughly document injury related treatment, lost wage and other expense history and develop a comprehensive settlement strategy; utilize appropriate medical, wage and other expense claim investigation forms and form letters. Compliance with Standard Operating Procedures, Regulatory and Statutory requirements and / or Best Practices in the processing of all claims.

Claims Administration and Investigation : Obtain and analyze loss details and develop a comprehensive strategy to efficiently and accurately reach resolution on claims presented for coverage. Keep all customers and relevant representatives informed of the claims process and claim status using professional written and verbal communications. Examine insurance policy provisions, endorsements, state statutory provisions and other records to verify applicable coverage. Systematically research and resolve coverage issues identified during the coverage investigation. Conduct liability investigations utilizing investigative tools and processes to include obtaining recorded statements from involved parties, interpreting and decoding police reports, analyzing scene investigations and expert reports and interpreting state negligence laws, statutory provisions and case law. Maintain a current diary on all claims. Thoroughly and accurately document the progression of each claim.

Communications and Customer Service : Exhibit effective verbal and written communication; deliver clear, timely messages that are easily understood. Demonstrate an awareness of different communication styles and express appropriate levels of empathy and sensitivity in communications. Anticipate customer needs, communicate decisions, define expectations and fulfill commitments to involved parties. Develop and implement negotiation strategies when communicating settlement related information to insured’s, claimants, attorneys, medical providers and other parties.

Claims Fraud Identification and Prevention : Partners with SIU to identify red flags, and when appropriate, referral criteria and referral guidelines. Investigates coverage and loss details to identify incidents of misrepresentation and suspicious patterns or activities. Conduct appropriate analyses, obtain needed information and follow Standard Operating Procedures and appropriate guidelines to ensure effective and efficient resolution of claim. Develop a comprehensive strategy, in working with our SIU partners, to complete and resolve any SIU related claims. Research, interpret and communicate, to appropriate team members, situational awareness for new red flag indicators.

Advanced Claims Handling : Work closely with the Team Manager, Sr. Manager and / or Director and defense attorney, when applicable, to respond timely, accurately and professionally to plaintiff representative’s verbal and written correspondence. Establish accurate loss and expense reserves; develop a comprehensive strategy and complete arbitrations and / or pre-suit demands timely. Understand and document arbitration and PSD stages, strategies and cost control measures. Research, interpret and communicate to appropriate team members applicable case law related to property damage and bodily injury related claims. Consider alternative dispute resolution methods when applicable. Properly recognize and handles any Medicare reporting requirements, CMS requests and / or demands.

Job Qualifications :

Undergraduate degree or equivalent work experience required.

Must possess applicable state license.

Two plus years of experience as a Claims Adjuster preferred.

Working towards a professional designation a plus.

Demonstrates effective and diplomatic oral and written communication skills.

Software application knowledge of Word and Excel for communication and data gathering and analysis.

Software application knowledge in Medical Bill Repricing Systems, presentation software such as WebEx, Office Communicator or other screen sharing system, and PowerPoint or other presentation / training type software is a plus.

Demonstrates ability to mentor and / or train others.

This is an in office job

Kemper is proud to be an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, disability status or any other status protected by the laws or regulations in the locations where we operate. We are committed to supporting diversity and equality across our organization and we work diligently to maintain a workplace free from discrimination. Kemper does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Kemper and Kemper will not be obligated to pay a placement fee.

Kemper will never request personal information, such as your social security number or banking information, via text or email. Additionally, Kemper does not use external messaging applications like WireApp or Skype to communicate with candidates. If you receive such a message, delete it.

Kemper at a Glance

The Kemper family of companies is one of the nation’s leading specialized insurers. With approximately $13 billion in assets, Kemper is improving the world of insurance by providing affordable and easy-to-use personalized solutions to individuals, families and businesses through its Kemper Auto and Kemper Life brands. Kemper serves over 4.8 million policies, is represented by approximately 22,200 agents and brokers, and has approximately 7,500 associates dedicated to meeting the ever-changing needs of its customers. Learn more at Kemper.com .

• Alliance United Insurance Company is not rated.

We value diversity and strive to be an employer of choice. An Equal Opportunity Employer, M / F / D / V

Our employees enjoy great benefits :