Florida Auto PIP / Medical Payments Adjuster
$45,000–$65,000 year
On-siteMiami, Florida, United States
Job Summary
Review medical bills, records, and documentation for accuracy and compliance while applying Florida PIP statutes and fee schedules to determine appropriate payments. Communicate with insureds, claimants, attorneys, and medical providers to facilitate good faith settlements and negotiations with providers' offices. Document claim activity, maintain accurate claim files, and issue payments and explanations of benefits as appropriate. Identify potential fraud indicators and escalate when necessary, ensuring full compliance with company procedures and regulatory requirements. Manage claim workload to meet productivity and quality standards.
Required 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
Desired Qualifications
- Claims system experience preferred
- Florida Adjuster License (620 or equivalent)
- Experience with medical payments, excel and/or medical coding
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