PIP Coverage and Qualification Adjuster

**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 mat…