Claims Adjuster (MI PIP & Med Pay)
About the position
The Claims Adjuster position focuses on managing Michigan Personal Injury Protection (PIP) and Medical Payments (Med Pay) claims. Under general supervision, the adjuster will utilize independent judgment to investigate, evaluate, and resolve claims, determining the extent of the company's liability. This role requires a thorough understanding of policy provisions and the ability to assess coverage, compensability, liability, and damages. The adjuster will follow standard procedures while adhering to corporate policies and fair claims handling practices. In this role, the adjuster will be responsible for obtaining necessary information to properly investigate each claim. This includes corresponding with agents, insureds, claimants, witnesses, and other relevant parties. The adjuster will review and evaluate documentation such as applications, reports, and statements to ensure a comprehensive understanding of each case. Additionally, the adjuster will monitor claim outcomes through a self-audit process to ensure compliance with legal and regulatory standards. Customer service is a critical aspect of this position, as the adjuster will deliver superior service to policyholders and agents, ensuring timely resolution of claims service issues. The adjuster will set or recommend reserves based on the investigation results and manage claims within defined authority, preparing and maintaining detailed claim reports. The role may involve extensive interaction with various stakeholders, including conducting in-depth interviews, scene inspections, and attending settlement conferences or trials. The adjuster may also participate in project teams, contributing to project objectives, and may provide leadership and training to junior staff, offering input on their performance to management. Other duties may be assigned as necessary.
Responsibilities
Investigates claims to determine validity and extent of liability.
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Obtains information necessary to properly investigate and evaluate each case by corresponding with agents, insureds, claimants, witnesses, and others.
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Reviews and evaluates documentation, including applications, reports, and statements.
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Monitors appropriate claim outcomes through self-audit process.
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Delivers superior customer service to policyholders and agents, ensuring appropriate and timely resolution of claims service issues.
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Ensures legal, regulatory, and fair claims handling compliance.
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Sets or recommends reserves based on results of claim investigation.
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Manages, evaluates, and concludes claims within defined authority.
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Prepares and maintains claim reports.
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Conducts in-depth interviews and/or scene inspections.
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Attends settlement conferences and/or trials.
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May serve as a member of project teams, contributing to the achievement of project objectives.
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May provide leadership to junior staff by training and providing guidance.
Requirements
Two to four years related experience and/or training in claims adjusting or a related field.
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Associate's degree (A.A.) from a two-year college/technical school or equivalent combination of education and related experience/training.
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Ability to work legally in the United States; no visa sponsorship/support available.
Nice-to-haves
Benefits
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