Florida Auto PIP / Medical Payments Adjuster

Loyalty MGA LLC; Miami (FL); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Competitive base pay

Paid Time Off

Medical Insurance

Sick Time

Dental & Vision

Performance Bonus

401(k) with Match

Training & Development

Job summary

Loyalty MGA LLC is seeking a Florida Auto PIP / Medical Payments Adjuster to join our claims team in Miami. You will review medical bills, apply PIP statutes, and communicate with insureds and providers to ensure timely, accurate payments.

The role requires knowledge of Florida PIP regulations, strong organizational skills, and the ability to handle a high-volume caseload while maintaining compliance with company policies.

Qualifications

• Some Florida PIP or Medical Payments claims handling experience.
• Some knowledge of Florida PIP statutes and fee schedules.
• Experience reviewing medical bills and medical documentation.
• Excellent organizational and time management skills.
• Strong bilingual written and verbal communication skills.
• Ability to work independently and manage a high-volume caseload.

Responsibilities

• Review medical bills, records, and documentation for accuracy and compliance.
• Apply Florida PIP statutes and fee schedules to determine appropriate payments.
• Communicate with insureds, claimants, attorneys, and medical providers.
• Negotiate good faith settlements with providers' offices.
• Document claim activity and maintain accurate claim files.
• Issue payments and explanations of benefits (EOBs) as appropriate.
• Identify potential fraud indicators and escalate when necessary.
• Maintain compliance with company procedures and regulatory requirements.
• Manage claim workload to meet productivity and quality standards.

Skills

PIP claims

Medical payments

Medical bills review

Organizational skills

Bilingual communication

Independent work

High-volume caseload

Claims system experience

Education

Florida Adjuster License (620)

Tools

Claims system

Job description

Florida Auto PIP / Medical Payments AdjusterWe are seeking a detail-oriented and experienced Florida Auto PIP / Medical Payments Adjuster to join our claims team. This position is responsible for handling Personal Injury Protection (PIP) and Medical Payments claims in accordance with Florida statutes, policy provisions, Medicaid and Medicare fee schedule and company guidelines. The ideal candidate will have strong knowledge of Florida PIP regulations, and the ability to manage claims efficiently while providing excellent service to insureds and medical providers.Key Responsibilities:Review medical bills, records, and documentation for accuracy and complianceApply Florida PIP statutes and fee schedules to determine appropriate paymentsCommunicate with insureds, claimants, attorneys, and medical providersGood faith settlements/negotiations with provides officesDocument claim activity and maintain accurate claim filesIssue payments and explanations of benefits (EOBs) as appropriateIdentify potential fraud indicators and escalate when necessaryMaintain compliance with company procedures and regulatory requirementsManage claim workload to meet productivity and quality standardsQualifications:Some Florida PIP or Medical Payments claims handling experienceSome knowledge of Florida PIP statutes and fee schedulesExperience reviewing medical bills and medical documentationExcellent organizational and time management skillsStrong bilingual written and verbal communication skillsAbility to work independently and manage a high-volume caseloadClaims system experience preferredPreferred:Florida Adjuster License (620 or equivalent)Experience with medical payments, excel and/or medical codingABOUT USWe are a fast-growing, bilingual insurance agency serving clients across Florida and Texas! Our team helps families and businesses protect what matters most — through auto, home, life, and commercial insurance solutions built around each client’s needs.We are not your average insurance agency. We invest in our people, recognize performance, and create real paths for growth — from your first day in the office to owning your own location. If you are bilingual, driven, and want a career that rewards your work, you have found the right team.WHY JOIN USWe know talented bilingual insurance professionals have options. Here is what makes us different:✓ Real base pay — Competitive salary based on experience and license held✓ Paid Time Off — 1 week PTO to start, growing with tenure✓ Medical Insurance — Comprehensive health coverage for you✓ Sick Time — Dedicated sick time separate from your PTO✓ Dental & Vision — Comprehensive dental and vision coverage✓ Performance Bonus — Structured plan tied directly to your results✓ Supplemental Plans — Voluntary supplemental options available✓ Employee Referral — Earn rewards for bringing great talent in✓ Basic Life Insurance — Company-paid life insurance✓ Career Growth Path — CSR Agent Team Lead Manager Owner✓ 401(k) with Match — Invest in your retirement savings with us!✓ Training & Development — Ongoing sales, product, customer service & compliance trainingOUR CORE VALUES“The harder we work, the luckier we are.”️PROTECTSafety for our communitiesWe ensure the safety of our communities by offering robust insurance options for life’s many facets. Quality and comprehensiveness are the hallmarks of our coverage.HELPSwift, personalized supportOur agents are ready to assist with any insurance questions, providing swift and personalized support to guide clients through their options.PROMOTEInvesting in our workforceWe invest in the future of our workforce with career paths and training for aspiring agents, contributing to the growth of the insurance sector.BUILDTrust & transparencyOur client relationships are built on trust and transparency, with each interaction tailored to meet individual insurance needs.EDUCATE & GUIDEClarity & empowermentClarity and empowerment are the goals of our resources, aimed at helping clients make informed insurance decisions.PROVIDEAccessible solutionsWe deliver affordable and innovative insurance solutions made readily accessible through tools like our app, enhancing convenience for our clients.