Personal Injury Protection (PIP) Claims Representative

Florida Farm Bureau General Insurance Company; Gainesville (FL); Hybrid; USD 36,000 - 54,000; Full time

Job summary

Florida Farm Bureau General Insurance Company in Gainesville is seeking a Personal Injury Protection (PIP) Claims Representative to manage and adjust medical insurance claims under PIP and Medpay coverage. The role requires reviewing and processing claims, determining coverage, and communicating with claimants and providers.

Ideal candidates will have a high school diploma, be willing to obtain an adjuster license within 6 months, and possess strong customer service, English communication, and

Qualifications

• High school diploma required; adjuster license within 6 months.
• Customer service experience helpful.
• Familiarity with medical terminology and treatment protocols beneficial.

Responsibilities

• Review, investigate, and process PIP/Medpay claims per laws and policy.
• Determine coverage, medical necessity, and reasonableness of charges.
• Communicate with claimants, providers, and attorneys to gather docs.
• Maintain detailed, accurate claim files and documentation.
• Provide clear, empathetic communication to claimants and stakeholders.
• Address inquiries and resolve issues promptly and professionally.
• Prepare reports and summaries for management as needed.
• Regular and predictable attendance required.

Skills

Customer service experience

Familiarity with medical terminology

English communication skills

Technical aptitude

PC skills

Math skills

Education

High school diploma

Adjuster license within 6 months

Job description

We believe that helping you is what we do best. We achieve this goal by operating as a team with each employee playing an important role. We are a statewide "Equal Opportunity Employer" offering positions such as: clerical support, policy processing, administrative, management, computer information systems, claims, finance and underwriting.

Personal Injury Protection (PIP) Claims Representative

SUMMARY: We are looking for a PIP Claims Rep to work in our Gainesville office. You will be responsible for managing and adjusting medical insurance claims under Personal Injury Protection and/or Medical Payments coverage.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Review, investigate, and process PIP and/or Medpay claims in accordance with applicable laws and policy provisions.
• Determine coverage eligibility, verify medical necessity, and assess reasonableness of charges.
• Communicate with claimants, medical providers, attorneys, etc. to gather necessary documentation to resolve claims.
• Maintain detailed and accurate claim files and documentation.
• Provide clear and empathetic communication to claimants and stakeholders.
• Address inquiries and resolve issues promptly and professionally.
• Prepare reports and summaries for management as needed.
• Regular and predictable attendance is required.

QUALIFICATION REQUIREMENTS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

• H.S. Diploma is required
• Must obtain Adjuster’s license in 6 months
• Customer service experience
• Familiarity with medical terminology & treatment protocols

SKILLS/ABILITY

• Proficient in English written and Verbal communication skills
• Possesses strong technical aptitude
• Proficient PC skills
• Good math skills

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all the essential duties, responsibilities and requirements of personnel.