PIP Coverage and Qualification Adjuster

United Auto Insurance; Miami (FL); Remote; USD 55,000 - 75,000; Full time

Benefits offered by this job

401(k) match

Medical Insurance

Paid time off

Flexible spending accounts

Life Insurance

Disability

Job summary

United Automobile Insurance Company seeks a Coverage and Qualification Adjuster to review Personal Injury Protection claims remotely. The role requires an active adjuster license (FL or TX) and a background in PIP claims, underwriting, and regulatory compliance.

You will assess coverage, analyze medical records, and communicate decisions to claimants while maintaining detailed files and timely settlements.

Qualifications

• Active Adjuster's license required.
• Associate or Bachelor's degree preferred and/or 3+ years in related work, preferably with PIP claims.

Responsibilities

• Review and assess PIP claims to determine coverage eligibility.
• Analyze medical records and reports to evaluate injuries and loss.
• Interpret policies and state regulations to determine coverage.
• Communicate with claimants and professionals to gather information.
• Issue payments for approved claims per policy and guidance.
• Ensure compliance with laws and company policies and document findings.

Skills

Bilingual (English & Spanish)

Analytical skills

Negotiation

Communication

Guidewire

Microsoft Office

Education

Associate or Bachelor's degree

Active Adjuster's license

Tools

Guidewire

MS Word/Excel

Job description

COMPANY OVERVIEW

Founded in 1989, United Automobile Insurance Company is an innovative and established organization looking for [a] Coverage and Qualification Adjuster(s) to join our team. Family-owned, UAIC, is one of the largest privately held property and casualty insurance companies in the United States. The key to our growth and success is a commitment to providing quality service to our agents and customers, by providing disciplined underwriting, and strategic claims handling. Our ongoing efforts to invest substantial resources in personnel and technology are the foundation of our promise of assuring maximum efficiency and specialized operations in the industry. We are proud that our independent agents and customers have recognized our dedication by making UAIC the market leader in every state where we conduct business.

Auto PIP Claims experience required -This is a fully remote opportunity, and the ideal candidate will have an active adjuster's license, in Florida or Texas.

SCOPE

As a Coverage and Qualification Adjuster, you will be responsible for reviewing and processing Personal Injury Protection claims, ensuring compliance with company policies and state regulations. This role involves assessing the validity of claims, determining coverage limits, and facilitating timely and accurate settlements.

DUTIES

• Review and assess PIP claims to determine coverage eligibility.
• Analyze medical records, police reports, and other relevant documents to evaluate the extent of injuries and to establish proof of loss.
• Interpret insurance policies, contracts, and state regulations to determine the extent of coverage applicable to each claim.
• Communicate with claimants, medical professionals, attorneys, and other parties involved in the claim process to gather necessary information and documentation.
• Provide clear and concise explanations of coverage decisions to claimants.
• Conduct interviews with claimants to gather necessary information that supports an objective final disposition of the claims. These interviews may be conducted under oath or via phone.
• Maintain accurate and organized claim files with all pertinent information, including correspondence, medical records, and assessment reports.
• Issue payments for approved claims in accordance with company policies.
• Ensure compliance with state laws, regulations, and company policies in all claim handling activities.
• Generate and submit reports on claims activity, trends, and performance metrics.
• Identify and investigate potentially fraudulent activities related to PIP claims.
• Collaborate with the special investigation unit (SIU) when fraud is suspected.
• Provide excellent customer service by addressing inquiries, concerns, and providing timely updates to claimants.
• Prepare reports and documentation for internal purposes, regulatory compliance, and potential legal proceedings.

EDUCATION

• Associate or bachelor's degree preferred and/or a minimum of 3 years of related work experience, preferably with PIP claims.
• Active Adjuster's license required

SKILLS & EXPERIENCE

• Bilingual (English & Spanish) preferred
• Knowledge of insurance principles, policies, and procedures.
• Strong analytical, negotiation, and communication skills.
• Ability to work independently and efficiently manage a caseload.
• Proficient in Guidewire, Word, Excel, Windows-based applications and internet usage.
• Must be familiar with forms, procedures, regulations, coverages, and claims processes.
• Must be able to exercise good judgment and state opinions assertively.
• Must be able to write and speak clearly and concisely.
• Must be able to perform work effectively in a highly intense environment and handle multiple tasks and demands simultaneously.
• Must illustrate analytical skills to identify, gather, and organize information.
• Must be able to work independently in a team environment.

BENEFITS

• 401(k) Retirement Savings Plan with employer match.
• Comprehensive Medical, Prescription Drug, Vision, and Dental Insurance
• Paid Time Off, Holidays, and Leave programs.
• Flexible spending accounts
• Basic Life Insurance and Voluntary Life/ADD
• Short Term and Long-Term Disability

UAIC participates in the E-Verify program to confirm the employment eligibility of all newly hired employees. For more information about E-Verify, please visit https://www.e-verify.gov/.

UAIC is an Equal Opportunity Employer and is committed to the principle of equal employment opportunity for all employees. All employment decisions at UAIC are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion, or belief, family or parental status, or any other status protected by the laws or regulations in the locations where we operate.

PIP Coverage and Qualification Adjuster