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Tailor your resume to this NO-FAULT PIP ADJUSTER role.
Rezi rewrites your resume against HEREFORD INSURANCE COMPANY's job description. Free.
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Don't guess if your resume is good enough.
See how it scores against the NO-FAULT PIP ADJUSTER posting at HEREFORD INSURANCE COMPANY — free, in seconds.
About the Role
This vital and highly analytical position is responsible for the adjustment of complex No-Fault claims. The role requires familiarity with New York State Insurance Department regulations, fraud identification, and various claims processes including peer reviews, independent medical examinations (IME), arbitration, subrogation, and legal suits.
Responsibilities
- Initiate investigative techniques (EUO, SIU) as part of the claims process.
- Make coverage determinations and request appropriate investigation to facilitate proper handling of files.
- Forward NF1, NF2 Forms upon receiving a new No-Fault claim.
- Make immediate contact with the applicant or their representative to gather information necessary for claim adjustment.
- Index all No-Fault applicants (ISO), record and monitor responses.
- Maintain a diary of all assigned files.
- Review all No-Fault communications received on assigned files.
- Review and monitor files for closing.
- Review all medical and expense bills for duplication and issue payment as appropriate.
- Follow HIC’s No-Fault Vendor procedures for initiating independent medical examinations.
- Manage medical aspects through proper use of IME and peer reviews, and appropriate requests for verification.
- Request six-month EOBs and review/document files with action plans and injury/medical status.
Requirements
- Must be conversant in NYS Insurance Department, Regulations 68.
- Ability to work in Windows software applications.
- Minimum of 2 years handling No Fault claims.
Skills
- No-Fault claims adjustment
- NYS Insurance Department, Regulations 68
- Fraud identification and referral
- No-Fault forms
- Peer review monitoring
- Independent medical examinations (IME)
- Claim denial processes
- Arbitration
- Subrogation
- Legal suits resulting from claims
- Investigative techniques (EUO, SIU)
- Coverage determinations
- Windows software applications
Experience Level
- Minimum of 2 years handling No Fault claims