New York Personal Injury Protection Adjuster - Remote

At Allstate, great things happen when our people work together to protect families and their belongings from life’s uncertainties. And for more than 90 years, our innovative drive has kept us a step ahead of our customers’ evolving needs. From advocating for seat belts, air bags and graduated driving laws, to being an industry leader in pricing sophistication, telematics, and, more recently, device and identity protection. 

• →May participate in one or more moderately complex special assignments
• →May serve as a committee team lead for smaller projects or as a committee team member on medium projects
• →Reviews subpoenas and non-complex demands (e.g., Florida demands)
• →May serve as an agent advocate
• →May prepare and negotiate moderately complex subrogation issues or arbitrations

• Makes and maintains a connection with the customer by understanding and meeting their needs; serves the customer with empathy; and follows up to ensure that customer needs have been met
• Researches and responds to moderately complex customer communications, concerns, conflicts, or issues
• File Documentation and Reporting
• Summarizes documents and enters claim system notes
• Documents a claim file with notes, evaluations, and decision-making process
• Processes medical bills and recognizes medical management opportunities

• Assesses medical/physical condition and prior injuries of claimant, and obtains and analyzes medical bills, wage loss reviews, home service or attendant care, mileage payments, and other related claims to determine reasonableness of charges and relation of injuries to accident, and to ensure compliance with fee schedules, and detect duplicate billing
• Conducts first party file processing/fact gathering, including interviewing claimant, witnesses, medical providers, etc
• Evaluates medical records and treatment plan of claimant and determines if continued treatment is reasonable
• Sets up IME and reviews results
• Investigates, reviews, and accepts or rejects moderately complex coverage and other potential coverage; and investigates coverage denial questions
• Determines appropriate benefit and negotiates and settles moderately complex claims, including resolution of moderately complex usual and customary billings
• Monitors treatment and benefit payments for excessive, unreasonable, or abusive claims
• Handles specialized claims

• Strong knowledge of insurance policies, particularly personal injury protection coverage and relevant regulations
• Ability to evaluate claims by reviewing accident reports, medical records, and other documents
• Excellent communication skills for effectively interacting with claimants, medical providers, and other stakeholders
• Strong investigative and research skills to gather information and uncover relevant facts
• Analytical and critical thinking abilities to assess medical records, calculate reimbursement amounts, and make informed decisions
• Negotiation skills to resolve disputes, reach settlements, and establish payment plans
• Effective time management and organizational skills to handle multiple claims and meet deadlines
• Commitment to providing excellent customer service, showing empathy and professionalism
• Basic understanding of relevant laws and regulations related to insurance and personal injury cases

#LI-JB1

Allstate generally does not sponsor individuals for employment-based visas for this position.

Effective July 1, 2014, under Indiana House Enrolled Act (HEA) 1242, it is against public policy of the State of Indiana and a discriminatory practice for an employer to discriminate against a prospective employee on the basis of status as a veteran by refusing to employ an applicant on the basis that they are a veteran of the armed forces of the United States, a member of the Indiana National Guard or a member of a reserve component.

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Allstate provides a comprehensive technology setup, including a laptop, monitors, headset, keyboard, and mouse. Employees eligible to work from home also receive a monthly connectivity reimbursement to help offset internet costs.

When working from home, you must have a dedicated, private workspace free from distractions, along with appropriate desk and seating. Reliable internet is required, with minimum speeds of 50 MB download and 5 MB upload.

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