Med/PIP Claims Handler – Colorado – Farmers Insurance Group – Colorado

Proactively processes Med Pay and/or Personal Injury Protection (PIP) claims while delivering superior customer service. Confirms coverage and eligibility. Investigates and establishes damages. Negotiates and/or pays assigned claims. Communicates with claim owners and other specialists to facilitate claim resolution.

Candidates must reside in Colorado.

*Sign on bonus available*

• Makes timely contact with customer.
• Explains claims process to customer.
• Explains policy benefits to customer.
• Confirms facts of loss.
• Establishes expectations (future contact timing, method of contact, etc.)
• Determines policy coverage applicability.
• Identifies policy and coverage issues and escalates to supervisor.
• Secures supporting documents such as, medical records, bills, and wage loss verification.
• Identifies subrogation opportunities and refers claim to Subrogation department to follow-up.
• Obtain additional information from all parties as needed to confirm proximate cause of loss and mechanism of injury.
• Recognizes potential fraudulent claims and escalates to supervisor for review.
• Communicates with underwriting on policy issues.
• Evaluation reviews and analyzes medical bills, records, wage loss documentation, and other information.
• Reviews all investigation materials for causal relationship between the claim incident and the injuries reported.
• Utilizes available resources and tools to ensure accuracy of evaluation of medical treatment.
• Assesses owed benefits.
• Reviews claims with more complex investigation questions or issues with supervisor.
• Identifies need for medical intervention, such as an Independent Medical Exam or peer review, and initiates the process.
• Recognizes and resolves disputes over covered benefits, medical bill amounts, etc. with customer or provider as appropriate.
• Negotiates and settles claims based on the merits of the claim.
• Proactively manages claim inventory to ensure all assigned claims are handled to completion in a timely fashion, including follow-up contacts, bill payment, etc., compliant with regulatory requirements.
• Utilizes claim system and other technologies to document file activities, strategy, and communication with customers, attorneys and medical providers.
• Ensures that all correspondence to customers is appropriate and professional.
• Discusses status of injuries and medical treatment plans with customers and medical providers
• Identifies Medicare eligibility and provides appropriate notification to customer as required.
• Responds to customer and provider inquiries and resolves complaints promptly.
• Completes assigned training and activities to develop the knowledge, skills and abilities required to complete the job duties.
• Handle claims in AR, CO, IA, KS, MN, MO, NE, NM OK, SD, TX, WI & WY.
• Performs other duties as assigned.

• High school diploma or equivalent required.
• Bachelor’s degree preferred.

• Basic critical thinking, negotiation, analytical and time management skills.
• Strong customer service skills.
• Proficient in use of computer, internet and Microsoft Office applications (Word, Excel).
• General work experience with demonstrated customer service and time management skills is preferred.
• Maintain an active adjuster’s license in states as required.