Farmers Insurance is dedicated to delivering peace of mind to customers through protection and comprehensive advice. The Bristol West Med Pay/PIP representative conducts claims investigations and manages first party medical claims, ensuring prompt and proactive handling of claims settlements.
Responsibilities
- Evaluates Personal Injury Protection (PIP) and Med Pay claims for eligibility, medical necessity, and appropriateness of charges in accordance with state fee schedules
- Determines relatedness, causation, and appropriateness of treatment based on the compensable injury
- Provides reserve recommendations and makes payment approval to ensure activities are consistent with corporate policies
- Conducts detail bill reviews and process claims within designated authority levels
- Makes contacts with stakeholders to investigate and process claims
- Contacts may include multiple attempts to communicate with various parties and requires telephone conversations or other methods of communication to be a priority
- Parties involved could include policy holders, claimants, agents, witnesses, contractors, police and fire departments, state and county fraud and arson personnel, special investigators, attorneys, expert witnesses, members of the medical profession and other persons pertaining to the investigation and processing of claims
- Performs other duties as assigned
Skills
- High school diploma or equivalent required
- Strong verbal communication and listening skills
- Strong written communication skills with the ability to convey critical decisions and information through written letters
- Demonstrates excellent judgment and decision-making skills
- Effective negotiation skills
- Possesses flexibility to work in a fast-paced, dynamic environment; uses discretion to modify work practices and processes to achieve results or improve efficiency
- Demonstrated problem-solving skills. Takes a broad perspective on problems and spots new, less obvious solutions
- Performs work independently with minimal supervision
- Possesses strong technical aptitude; Proficient in Microsoft Office products. Adaptable and flexible to new technology
- Effective conflict management skills. Identifies key issues and patterns from partial/conflicting data
- Strong skills in multi-tasking and working with a sense of urgency
- Less than one year of Insurance industry or related experience preferred
- Bachelor's degree preferred
Benefits
- Medical
- Dental
- Vision
- Health Savings and Flexible Spending Accounts
- Life Insurance
- Paid Time Off
Company Overview
The companies comprising the Farmers Insurance Group of Companies® currently make up one of the country's largest insurers of vehicles, homes and small businesses, and provide a wide range of other specialty insurance and financial services products. It was founded in 1928, and is headquartered in Los Angeles, California, USA, with a workforce of 10001+ employees. Its website is https://www.farmers.com.
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