Claims Med​/PIP Specialist

Select how often (in days) to receive an alert:

36083

At Farmers, we’re not just known for unforgettable jingle – we’re a team with a passion for purpose and making a real difference in people’s lives. We deliver peace of mind when it matters most. Our results-driven, high-performance culture thrives on creativity, accountability and bold solutions. Here, growth isn’t just a goal – it’s a way of life for both the organization and every individual on our team.

We tackle challenges head-on, learn from every experience and measure our impact on the customers who trust us.

Join an award-winning, equal opportunity employer, where you’ll find more than a job – you’ll find a supportive community. Enjoy competitive benefits, take part in meaningful volunteer projects, and help shape the future alongside talented colleagues across all backgrounds. At Farmers, helping others is at the heart of what we do.

Farmers believes in a culture of collaboration, creativity, and innovation, which thrives when we have the ability to work flexibly in a virtual setting as well as the opportunity to be together in person. Our hybrid work environment combines the best of both worlds with at least three (3) days in office and up to two (2) days virtual for employees who live within fifty (50) miles of a Farmers corporate office.

Applicants beyond fifty (50) miles may still be considered.

Residency Requirement:
This role requires residence in Michigan.

This position offers a minimum starting wage of $26.01 per hour or higher. Compensation may be adjusted upward based on relevant experience, skills, and qualifications.

• Proactively processes Med Pay and/or Personal Injury Protection (PIP) claims while delivering superior customer service.
• Confirms coverage and eligibility. Investigates and establishes damages.
• Negotiates and/or pays assigned claims.
• Communicates with claim owners and other specialists to facilitate claim resolution.

Customer Relationship

• Makes timely contact with customer
• Explains claims process to customer
• Explains policy benefits to customer
• Confirms facts of loss
• Establishes expectations (future contact timing, m method of contact, etc.)
• Determines eligibility
• Identifies policy and coverage issues and escalates to supervisor
• Secures supporting documents such as, medical records, bills, and wage loss verification
• Identifies subrogation opportunities and refers claim to Subrogation department to follow-up
• Obtain additional information from all parties as needed to confirm proximate cause of loss and mechanism of injury
• Recognizes potential fraudulent claims and escalates to supervisor for review
• Communicates with underwriting on policy issues

Evaluation

• Reviews and analyzes medical bills, records, wage loss documentation, and other information
• Reviews all investigation materials for causal relationship between the claim incident and the injuries reported
• Utilizes available resources and tools to ensure accuracy of evaluation of medical treatment
• Assess owed benefits Reviews claims with more complex investigation questions or issues with supervisor

Claim Resolution

• Identifies need for medical intervention, such as an Independent Medical Exam or peer review, and initiates the process
• Recognizes and resolves disputes over covered benefits, medical bill amounts, etc. with customer or provider as appropriate
• Negotiates and settles claims based on the merits of the claim

File Management

• Proactively manages claim inventory to ensure all assigned claims are handled to completion in a timely fashion, including follow-up contacts, bill payment, etc., compliant with regulatory requirements
• Utilizes claim system and other…