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.

Under general supervision, this job is responsible for handling the medical portion of auto accident claims for the insured or other injured parties found to be eligible under a personal injury protection and/or medical payment benefits where the policy limits or exposure to the company is limited and occasionally when the policy limits or exposure to the company is moderate. This individual determines coverage and assesses medical claims, evaluates medical bills, and initiates or reviews potential fraud investigations as warranted. The individual explains coverage, negotiates and settles claims, and follows up with the customer on continuing treatments while delivering compassionate service that is fast, fair, and easy, to ensure customer retention. At this level, the individual typically negotiates and settles moderately complex claims, such as claims in less regulated and occasionally moderately regulated states (or in some situations more complex claims with guidance as needed). The individual is capable of working independently, prioritizing the individual's own responsibilities, and managing the individual's own workload. The individual also consistently meets band level behaviors, production, quality, and/or customer service goals. Allstate Benefits Being a part of Allstate means you receive a benefits package from Day 1 of employment.  This includes time off, healthcare, retirement, and more.  That is why as an Allstater, you’ll enjoy a Total Rewards package that includes: Competitive pay with needed support for continuous development and career advancement. Flexibility in scheduling and a time off policy that helps support your work/life balance. Initial and ongoing training to get you proficient in your new role Comprehensive benefits like a 401K/pension, education reimbursement, and programs to help you balance work with the rest of your life. Visit  www.allstategoodlife.com  to learn more. Schedule - candidates selected will be aligned to an Eastern Time Zone schedule, Monday-Friday between the hours of 8am-5pm EST.

Customer Service 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 Medical Management (1st Party) 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