New York Personal Injury Protection Adjuster - Remote

At Allstate, great things happen when our people work together to protect families and their belongings from life’s uncertainties. And for more than 90 years, our innovative drive has kept us a step ahead of our customers’ evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection. 

Job Description

Under general supervision, this job is responsible for handling the medical portion of auto accident claims for the insured or other injured parties found to be eligible under a personal injury protection and/or medical payment benefits where the policy limits or exposure to the company is limited and occasionally when the policy limits or exposure to the company is moderate. 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 delivering compassionate service that is fast, fair, and easy, to ensure customer retention.

At this level, the individual typically negotiates and settles moderately complex claims, such as claims in less regulated and occasionally moderately regulated states (or in some situations more complex claims with guidance as needed). The individual is capable of working independently, prioritizing the individual's own responsibilities, and managing the individual's own workload. The individual also consistently meets band level behaviors, production, quality, and/or customer service goals.

Allstate Benefits

Being a part of Allstate means you receive a benefits package from Day 1 of employment.  This includes time off, healthcare, retirement, and more.  That is why as an Allstater, you’ll enjoy a Total Rewards package that includes:

• Competitive pay with needed support for continuous development and career advancement.
• Flexibility in scheduling and a time off policy that helps support your work/life balance.
• Initial and ongoing training to get you proficient in your new role
• Comprehensive benefits like a 401K/pension, education reimbursement, and programs to help you balance work with the rest of your life. Visit www.allstategoodlife.com to learn more.

Schedule - candidates selected will be aligned to an Eastern Time Zone schedule, Monday-Friday between the hours of 8am-5pm EST.

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
• Researches and responds to moderately complex customer communications, concerns, conflicts, or issues
• File Documentation and Reporting
• Summarizes documents and enters 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 to determine 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
• Sets up IME and reviews results
• Investigates, reviews, and accepts or rejects moderately complex coverage and other potential coverage; and investigates coverage denial questions
• Determines appropriate benefit and negotiates and settles moderately complex claims, including resolution of moderately complex usual and customary billings
• Monitors treatment and benefit payments for excessive, unreasonable, or abusive claims
• Handles specialized claims

Other Projects and Responsibilities

• May participate in one or more moderately complex special assignments
• May serve as a committee team lead for smaller projects or as a committee team member on medium projects
• Reviews subpoenas and non-complex demands (e.g., Florida demands)
• May serve as an agent advocate
• May prepare and negotiate moderately complex subrogation issues or arbitrations

To be successful in this role, a PIP Adjuster should possess the following skills:

• Strong knowledge of insurance policies, particularly personal injury protection coverage and relevant regulations
• Ability to evaluate claims by reviewing accident reports, medical records, and other documents
• Excellent communication skills for effectively interacting with claimants, medical providers, and other stakeholders
• Strong investigative and research skills to gather information and uncover relevant facts
• Analytical and critical thinking abilities to assess medical records, calculate reimbursement amounts, and make informed decisions
• Negotiation skills to resolve disputes, reach settlements, and establish payment plans
• Effective time management and organizational skills to handle multiple claims and meet deadlines
• Commitment to providing excellent customer service, showing empathy and professionalism
• Basic understanding of relevant laws and regulations related to insurance and personal injury cases

#LI-JB1

Skills

Business Communications, Critical Thinking, Curious Mindset, Customer Handling, Fraud Investigations, Information Collection, Time Management, Time Prioritization

Compensation

Compensation offered for this role is 51,500.00 - 78,575.00 annually and is based on experience and qualifications.

The candidate(s) offered this position will be required to submit to a background investigation.

 

Joining our team isn’t just a job — it’s an opportunity. One that takes your skills and pushes them to the next level. One that encourages you to challenge the status quo. One where you can shape the future of protection while supporting causes that mean the most to you. Joining our team means being part of something bigger – a winning team making a meaningful impact.

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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For jobs in Los Angeles, please click “here” for information regarding the Los Angeles Fair Chance Initiative for Hiring Ordinance.

To view the “EEO Know Your Rights” 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.

 

Allstate provides a comprehensive technology setup, including a laptop, monitors, headset, keyboard, and mouse. Employees eligible to work from home also receive a monthly connectivity reimbursement to help offset internet costs.

 

When working from home, you must have a dedicated, private workspace free from distractions, along with appropriate desk and seating. Reliable internet is required, with minimum speeds of 50 MB download and 5 MB upload.

 

To help create a more personal and engaging experience, we ask that you join with your camera on if your interview is virtual. Please also have a Valid Photo Identification available at the start of your interview.  If you require any accommodations or have questions ahead of your interview please reach out to your recruiter.

 

Note: Internal candidates are only asked to join on video; a Valid Photo Identification is not needed for the interview.