Florida Auto PIP / Medical Payments Adjuster

Florida Auto PIP / Medical Payments Adjuster

We are seeking a detail-oriented and experienced Florida Auto PIP / Medical Payments Adjuster to join our claims team. This position is responsible for handling Personal Injury Protection (PIP) and Medical Payments claims in accordance with Florida statutes, policy provisions, Medicaid and Medicare fee schedule and company guidelines. The ideal candidate will have strong knowledge of Florida PIP regulations, and the ability to manage claims efficiently while providing excellent service to insureds and medical providers.

Key Responsibilities:

• Review medical bills, records, and documentation for accuracy and compliance
• Apply Florida PIP statutes and fee schedules to determine appropriate payments
• Communicate with insureds, claimants, attorneys, and medical providers
• Good faith settlements/negotiations with provides offices
• Document claim activity and maintain accurate claim files
• Issue payments and explanations of benefits (EOBs) as appropriate
• Identify potential fraud indicators and escalate when necessary
• Maintain compliance with company procedures and regulatory requirements
• Manage claim workload to meet productivity and quality standards