No-Fault PIP Claims Adjuster - Complex, Law-Backed

Hereford Insurance Company; New York (NY); In loco; USD 50.000 - 60.000; Tempo pieno

Descrizione del lavoro

Hereford Insurance Company seeks a highly analytical No-Fault Claims Adjuster in New York. The role focuses on adjusting complex No-Fault claims, following NY Regulations 68, and identifying potential fraud for SIU referral.

The adjuster will manage investigations, vendor procedures, and medical bill reviews, ensuring proper claim handling and timely closures within HIC's No-Fault process.

Competenze

• Must be conversant in NYS Insurance Department, Regulations 68.
• Familiar with identifying potential fraud claims for SIU referral.
• Familiar with No-Fault forms and processes (IME, peer reviews).
• Knowledge of arbitration, subrogation, and No-Fault litigation processes.

Mansioni

• Initiate investigative techniques (EUO, SIU) as part of claims handling.
• Forward NF1, NF2 forms upon receiving a new No-Fault claim.
• Make immediate contact with applicant or representative to gather information.
• Index all No-Fault applicants (ISO) and monitor responses.
• Maintain a diary of all files assigned to the adjuster.
• Review No-Fault communications on assigned files.
• Review and monitor files for closing.
• Review medical and expense bills for duplication and issue payments as appropriate.
• Follow No-Fault Vendor procedures for IME initiation.
• Medically manage through IME and peer reviews and verification requests.
• Request six-month EOBs and document files with action plans.

Conoscenze

No-Fault claims adjusting

Analytical thinking

Communication skills

Strumenti

Windows

Descrizione del lavoro

Salary Range: $50,000.00 To $60,000.00 Annually

A vital and highly analytical position responsible for the adjustment of complex No-Fault claims. Must be conversant in NYS Insurance Department, Regulations 68; familiar with the process of identifying potential fraud claims for referral to HIC’s Special Investigation Unit (SIU); familiar with the use of all No-Fault forms; familiar with HIC’s No-Fault process to monitor peer reviews, independent medical examinations (IME), and the denial of No-Fault claims; familiar with the process of arbitration, subrogation, and legal suits resulting from No-Fault Claims adjusting.

• Initiate the relevant 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 his representative to gather information necessary to the adjustment of the claim.
• Index all No-Fault applicants (ISO), record and monitor responses.
• Maintain a diary of all files assigned to the adjuster.
• Review all No-Fault communications received on assigned files.
• Review and monitor files for closing.
• Review all medical and expense bills submitted for duplication, and issue payment as appropriate.
• Follow HIC’s No-Fault Vendor procedures for the initiation of independent medical examinations.
• medically manage through the proper use of ime and peer reviews as well as proper requests for verification.
request six month eobs and review and document files with action plans and injury and medical status.

Other Duties

This job description in no way states or implies that these are the only duties to be performed. You will be expected to follow any other job-related instructions and to perform other job-related duties as requested by your supervisor.

Qualifications

Must be conversant in NYS Insurance Department, Regulations 68; ability to work in Windows software applications.
Minium of 2 years handling No Fault claims.