NO-FAULT PIP ADJUSTER

A vital and highly analytical position responsible for the adjustment of complex No-Fault claims. Must be conversant in NYS Insurance Department, Regulations 68; familiar with the process of identifying potential fraud claims for referral to HIC’s Special Investigation Unit (SIU); familiar with the use of all No-Fault forms; familiar with HIC’s No-Fault process to monitor peer reviews, independent medical examinations (IME), and the denial of No-Fault claims; familiar with the process of arbitration, subrogation, and legal suits resulting from No-Fault Claims adjusting.

Essential Duties & Responsibilities

• Initiate the relevant investigative techniques (EUO, SIU) as part of the claims process. make coverage determinations and request appropriate investigation to facilitate proper handling of files.

• Forward NF1, NF2 Forms upon receiving a new No-Fault claim.

• Make immediate contact with the applicant, or his representative to gather information necessary to the adjustment of the claim.

• Index all No-Fault applicants (ISO), record and monitor responses.

• Maintain a diary of all files assigned to the adjuster.

• Review all No-Fault communications received on assigned files.

• Review and monitor files for closing.

• Review all medical and expense bills submitted for duplication, and issue payment as appropriate.

• Follow HIC’s No-Fault Vendor procedures for the initiation of independent medical examinations.

• medically manage through the proper use of ime and peer reviews as well as proper requests for verification.

request six month eobs and review and document files with action plans and injury and medical status.

Other Duties

This job description in no way states or implies that these are the only duties to be performed. You will be expected to follow any other job-related instructions and to perform other job-related duties as requested by your supervisor.

Qualifications

Must be conversant in NYS Insurance Department, Regulations 68; ability to work in Windows software applications.
Minium of 2 years handling No Fault claims.

Supervisory Responsibilities