Claims Med/PIP Specialist

Farmers Group Inc.; Grand Rapids, Northern (MI, KY); Hybrid; USD 54,000 - 62,000; Full time

Benefits offered by this job

Bonus Opportunity

401(k)

Medical

Vision

HSA/FSA

Job summary

Farmers is seeking a Claims Med/PIP Specialist in Michigan to proactively process Med Pay/PIP claims, confirm coverage, investigate damages, and negotiate settlements. The role emphasizes customer service, timely communications, and collaboration with other specialists to resolve claims. Hybrid work is offered with in-office and remote days for eligible candidates.

Residency in Michigan is required. Minimum starting wage is $26.01 per hour, with compensation potentially adjusted based on

Qualifications

• Strong critical thinking, negotiation, analytical, and time management skills.
• Proficient in computer technology, internet and Microsoft Office applications (Word, Excel).
• General work experience with customer service and time management is preferred.

Responsibilities

• Proactively processes Med Pay and/or PIP claims while delivering superior customer service.
• Confirms coverage and eligibility; investigates and establishes damages.
• Negotiates and/or pays assigned claims; communicates with claim owners and other specialists to facilitate resolution.

Skills

Critical thinking

Negotiation

Analytical skills

Time management

MS Office

Education

High school diploma or equivalent

Tools

Microsoft Office

Job description

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Claims Med/PIP Specialist

36083

We are Farmers – where ambition meets opportunity.

At Farmers, we’re not just known for unforgettable jingle – we’re a team with a passion for purpose and making a real difference in people’s lives. We deliver peace of mind when it matters most. Our results-driven, high-performance culture thrives on creativity, accountability and bold solutions. Here, growth isn’t just a goal – it’s a way of life for both the organization and every individual on our team. We tackle challenges head-on, learn from every experience and measure our impact on the customers who trust us.

Join an award-winning, equal opportunity employer, where you’ll find more than a job – you’ll find a supportive community. Enjoy competitive benefits, take part in meaningful volunteer projects, and help shape the future alongside talented colleagues across all backgrounds. At Farmers, helping others is at the heart of what we do.

Farmers believes in a culture of collaboration, creativity, and innovation, which thrives when we have the ability to work flexibly in a virtual setting as well as the opportunity to be together in person. Our hybrid work environment combines the best of both worlds with at least three (3) days in office and up to two (2) days virtual for employees who live within fifty (50) miles of a Farmers corporate office. Applicants beyond fifty (50) miles may still be considered.

Residency Requirement: This role requires residence in Michigan.

This position offers a minimum starting wage of $26.01 per hour or higher. Compensation may be adjusted upward based on relevant experience, skills, and qualifications.

Job Summary

• Proactively processes Med Pay and/or Personal Injury Protection (PIP) claims while delivering superior customer service.
• Confirms coverage and eligibility. Investigates and establishes damages.
• Negotiates and/or pays assigned claims.
• Communicates with claim owners and other specialists to facilitate claim resolution.

Essential Job Functions

Customer Relationship

• Makes timely contact with customer
• Explains claims process to customer
• Explains policy benefits to customer
• Confirms facts of loss
• Establishes expectations (future contact timing, m method of contact, etc.)
• Determines eligibility
• Identifies policy and coverage issues and escalates to supervisor
• Secures supporting documents such as, medical records, bills, and wage loss verification
• Identifies subrogation opportunities and refers claim to Subrogation department to follow-up
• Obtain additional information from all parties as needed to confirm proximate cause of loss and mechanism of injury
• Recognizes potential fraudulent claims and escalates to supervisor for review
• Communicates with underwriting on policy issues

Evaluation

• Reviews and analyzes medical bills, records, wage loss documentation, and other information
• Reviews all investigation materials for causal relationship between the claim incident and the injuries reported
• Utilizes available resources and tools to ensure accuracy of evaluation of medical treatment
• Assess owed benefits Reviews claims with more complex investigation questions or issues with supervisor

Claim Resolution

• Identifies need for medical intervention, such as an Independent Medical Exam or peer review, and initiates the process
• Recognizes and resolves disputes over covered benefits, medical bill amounts, etc. with customer or provider as appropriate
• Negotiates and settles claims based on the merits of the claim

File Management

• Proactively manages claim inventory to ensure all assigned claims are handled to completion in a timely fashion, including follow-up contacts, bill payment, etc., compliant with regulatory requirements
• Utilizes claim system and other technologies to document file activities, strategy, and communication with customers, attorneys and medical providers
• Ensures that all correspondence to customers is appropriate and professional
• Discusses status of injuries and medical treatment plans with customers and medical providers
• Identifies Medicare eligibility and provides appropriate notification to customer as required
• Responds to customer and provider inquiries and resolves complaints promptly
• Completes assigned training and activities to develop the knowledge, skills and abilities required to complete the job duties
• Performs other duties as assigned

Experience Requirements

• Strong critical thinking, negotiation, analytical, and time management skills.
• Proficient in use of computer technology, internet and Microsoft Office applications (Word, Excel).
• General work experience with demonstrated customer service and time management skills is preferred.

Education Requirements

• High school diploma or equivalent required.

Physical Actions & Environment

Required job duties are normally performed in a climate-controlled office environment,

• Bending, Pulling, Sorting, Carrying up to 20 lbs.
• Pushing, Climbing, Reaching, Standing, Walking, Kneeling
• Farmers offers a competitive salary commensurate with experience, qualifications and location.
• Bonus Opportunity (based on Company and Individual Performance)
• 401(k)
• Medical
• Vision
• Health Savings and Flexible Spending Accounts

Job Location(s): US - MI - Caledonia, US - MI - Grand Rapids, US - MI

Farmers will consider for employment all qualified applicants, including those with criminal histories, in accordance with the Los Angeles Fair Chance Initiative for Hiring Ordinance or other applicable law. Pursuant to 18 U.S.C. Section 1033, Farmers is prohibited from employing any individual who has been convicted of any criminal felony involving dishonesty or a breach of trust without prior written consent from the state Department of Insurance.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Farmers is an Equal Opportunity Employer and does not discriminate in any employer/employee relations based on race, color, religion, gender, sexual orientation, gender expression, genetic information, national origin, age, disability, marital status, military and veteran's status, or any other basis protected by applicable discrimination laws.