Claims Associate Adjuster - PIP (REMOTE)

Amerisure Insurance Company; Farmington Hills (MI); Hybrid; USD 52,000 - 68,000; Full time

Benefits offered by this job

Flexible work arrangements

401(k) with profit sharing

Health and welfare benefits

Paid time off

Job summary

Amerisure Insurance Company is recruiting for a Claims Adjuster Associate – PIP to support claim lifecycle tasks from policyholders, claimants and providers. The role blends in-office collaboration at a local location with remote work on non-office days, and requires knowledge of medical terminology, HIPAA, and medical billing.

Excel and claims software proficiency are essential. The successful candidate will assist adjusters, manage data entry, prepare filings, and communicate clearly with

Qualifications

• Associate's degree or equivalent combination of education and experience; RHIT preferred.
• 1 year of experience in a healthcare setting, insurance or claims preferred.
• Knowledge of medical terminology, HIPAA compliance, medical billing (EOBS, HICFA, CMS 1500 and small business forms) and coding practices required.
• Ability to obtain appropriate state licensing as required.
• Proficiency in Microsoft Office Suite with an emphasis on Excel required.
• Familiarity with claims management software preferred.
• Demonstrated ability to build positive relationships within the department and with external customers.
• Excellent verbal and written communication skills and strong attention to detail.

Responsibilities

• Respond to inquiries regarding claim status, payment receipt, or medical bills from policyholders, claimants, and providers.
• Obtain and verify information from policyholders, claimants, witnesses, and vendors to support accurate claim processing.
• Assist with claim documentation by preparing and submitting required filings and administrative requests.
• Draft and distribute correspondence in accordance with company standards and regulatory requirements.
• Maintain accurate claim records by entering data into the claims management system.
• Coordinate external vendors to support the claims process.
• Process payments and invoices in accordance with company policies and adjuster direction.
• Provide billing information to medical providers and explain denials and reconsiderations.

Skills

Medical terminology

HIPAA compliance

Medical billing

Coding practices

Excel

Communication

Education

Associate's degree or equivalent

RHIT preferred

Tools

Claims management software

Job description

Amerisure creates exceptional value for its partners, policyholders, and employees. As a property and casualty insurance company, Amerisure’s promise to our partner agencies and policyholders begins with a comprehensive line of insurance products designed to protect businesses, as well as the health and safety of every employee. With an A.M. Best “A” (Excellent) rating, Amerisure serves mid-sized commercial enterprises focused in construction, manufacturing and healthcare. Ranked as one of the top 100 Property & Casualty companies in the United States, we proudly manage nearly $1 Billion of Direct Written Premium and maintain $1.21 billion in surplus. Amerisure is currently recruiting for a Claims Adjuster Associate – PIP role. Knowledge of medical terminology, HIPAA compliance, medical billing (EOBS, HICFA, CMS 1500 and small business forms) and coding practices required. Candidates who live near one of our office locations will have the expectation of working in an office 2 days a week (Tuesday and Wednesday). Candidates who do not live near an office will have a remote work arrangement, with the expectation of coming into an office as business needs arise. The ideal candidate will also possess the following skill set.

Summary Statement

The PIP Claims Associate provides quality assistance to adjusters at all phases of the claim lifecycle to drive the claim to timely conclusion. Supports the success of the organization through interactions with agencies, policyholders, and employees. This individual will handle incoming calls and mail for the claims department and facilitate tasks and processes to aid the adjuster to process claims accurately and efficiently.

Essential Tasks/Major Duties

• Respond to inquiries from policyholders, claimants, injured persons, medical providers and other stakeholders regarding claim status, receipt of payment or medical bills, and other claim-related questions.
• Obtain and verify information by gathering missing or incomplete details from relevant parties, including policyholders, claimants, witnesses, and external vendors, to support accurate claim processing.
• Assist with claim documentation by preparing and submitting required state filings, closing documents, and other administrative support requests on behalf of adjusters.
• Draft and distribute correspondence to policyholders, claimants, injured persons, medical providers or agents in accordance with company standards and regulatory requirements.
• Maintain accurate claim records by entering data into the claims management system and ensuring all documentation is complete and up to date.
• Coordinate external vendors by engaging appraisers, attorneys, and contractors, to support the claims process.
• Process payments and invoices by reviewing and issuing payments in accordance with company policies and adjuster direction.
• Provide information and billing instructions to medical providers including gathering EOBs, and payment information. Explain coding and documentation denials including the process for reconsiderations.
• Assist with the capture of reimbursement from the MCCA for claims that have breached retention.
• Obtain HIPPA forms from injured persons and order medical records for the claim file.

Knowledge, Skills & Abilities

• Associate's degree or equivalent combination of education and experience. Registered Health Information Technician (RHIT) preferred.
• 1 year of experience in a healthcare setting, insurance or claims preferred.
• Knowledge of medical terminology, HIPAA compliance, medical billing (EOBS, HICFA, CMS 1500 and small business forms) and coding practices required.
• Ability to obtain appropriate state licensing as required.
• Proficiency in Microsoft Office Suite with an emphasis on Excel required.
• Familiarity with claims management software preferred.
• Demonstrated successful ability to build positive relationships and partnerships within department, across the organization and with external customers.
• Excellent verbal and written communication skills with the ability to interact with internal and external customers.
• Demonstrated ability to organize and prioritize work to ensure timely deadlines.
• Demonstrated ability to critically think and independently investigate assigned tasks in order to move items towards resolution.
• Demonstrated ability to input data with a high accuracy rating, and strong attention to detail.

Just as we are committed to creating exceptional value for our Partners For Success® agencies and policyholders, Amerisure also remains committed to being an employer of choice. We reinforce this commitment by adhering to an Employee Value Proposition that, in part, is provided through a competitive total rewards package. This package includes competitive base pay, performance-based incentive pay, comprehensive health and welfare benefits, a 401(k) savings plan with profit sharing, and generous paid time off programs. We also offer flexible work arrangements to promote work-life balance. Recognized as one of the Best and Brightest® Companies to Work For in the Nation and one of Business Insurance magazine’s Best Places to Work in Insurance, we provide a workplace that fosters excellence and professional growth. If you are looking for a collaborative and rewarding career, Amerisure is looking for you.

Amerisure Mutual Insurance Company is an Equal Employment Opportunity employer. Amerisure provides equal employment opportunities to all employees and applicants without regard to race, color, religion, sex (to include sexual orientation and gender identity), national origin, age, disability, genetic information, veteran status, or any other protected characteristic under applicable federal, state, or local laws. Amerisure complies with all applicable laws governing nondiscrimination in employment in all locations where the company operates. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training. Amerisure prohibits harassment or discrimination of any kind and is committed to maintaining a workplace free from unlawful harassment or discrimination. Amerisure prohibits retaliation against anyone who reports discrimination, participates in an investigation, or opposes unlawful practices. Any improper interference with an employee’s ability to perform their job duties may result in disciplinary action, up to and including termination.