Encompass PIP/Medical Billing and Coding Analyst

Bridgewater, New Jersey
Not Specified
Apr 12, 2018
Jun 11, 2018
Claims, IT
Job Type
Not Specified
Career Level
Not Specified

Where good people build rewarding careers.

Think that working in the insurance field cant be exciting, rewarding and challenging? Think again. Youll help us reinvent protection and retirement to improve customers lives. Well help you make an impact with our training and mentoring offerings. Here, youll have the opportunity to expand and apply your skills in ways you never thought possible. And youll have fun doing it. Join a company of individuals with hopes, plans and passions, all using and developing our talents for good, at work and in life.

Job Description

Encompass Insurance has an exciting opportunity for a Personal Injury Projection/Medical Payments Adjuster in Bridgewater, NJ!

About the Team

The Claims Department is here to restore peoples lives after the unexpected has happened. We work to deliver compassionate service that is fast, fair and easy. Putting our customers first to resolve their claim and taking the stress out of the situation is our goal. This is your chance to help make a meaningful difference in peoples lives. Join the thousands of people who work in the claims industry in highly stimulating work that will require you to assimilate data, evaluate facts and negotiate solutions to complex problems. Every day presents different learning and growth opportunities. You will gain a broad range of professional skills that will be equally applicable and highly valuable no matter where your career takes you.

About the Position

As a Personal Injury Projection/Medical Payments Adjuster you will be responsible for handling the medical portion of auto accident claims in which our Encompass customers are involved for the insured or other injured parties found to be eligible under a personal injury protection benefit where the policy limits or exposure to the company is limited and occasionally when the policy limits or exposure to the company is moderate. On moderately complex claims you will determine applicable coverage and assess medical claims, evaluate medical bills, and initiate potential fraud investigations as warranted. You will explain coverages, negotiate and settle claims, and follow up with customers on continuing treatments while delivering compassionate service that is fast, fair, and easy, to ensure customer retention.

Specific responsibilities include:

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 into 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 usual and customary billings

  • Monitors treatment and benefit payments for excessive, unreasonable, or abusive claims

  • Handles specialized claims

Job Qualifications

  • Medical coding certificate through professional coding program such as AAPC ( American Academy of Professional Coders ) or Ahima (American Health Information Management Association) is required

  • Must have knowledge of medical reimbursement and adjustments such as NCCI and MUE edits.

  • Prior medical claim handling preferred

  • High School Diploma/General Education Diploma is required, Bachelors Degree preferred

  • Excellent customer service skills and a passion to help others

  • Ability to be a self-starter and work independently but also in a team environment

  • Excellent time management skills

  • Critical thinking with the ability to make decisions with limited supervision

  • Strong organizational skills

  • Excellent oral, phone and written communication skills

  • Strong computer, typing and grammar skills

The candidate(s) offered this position will be required to submit to a background investigation, which includes a drug screen.

Good Work. Good Life. Good Hands.

As a Fortune 100 company and industry leader, we provide a competitive salary but thats just the beginning. Our Total Rewards package also offers benefits like tuition assistance, medical and dental insurance, as well as a robust pension and 401(k). Plus, youll have access to a wide variety of programs to help you balance your work and personal life -- including a generous paid time off policy.

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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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It is the policy of Allstate to employ the best qualified individuals available for all jobs without regard to race, color, religion, sex, age, national origin, sexual orientation, gender identity/gender expression, disability, and citizenship status as a veteran with a disability or veteran of the Vietnam Era.


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