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Hereford Insurance Company · 2 months ago

NF MED MGMT SPECIALIST

Long Island City, NY, US

Full-time

Onsite

Mid Level

$50K/yr - $60K/yr

Hereford Insurance Company is seeking a NF MED MGMT SPECIALIST, a vital and highly analytical position responsible for the adjustment of complex No-Fault claims. The role involves investigating claims, making coverage determinations, and managing medical reviews and payments.

Auto InsuranceCommercial InsuranceFinancial ServicesInsurance

Responsibilities

Initiate the relevant investigative techniques (EUO, SIU) as part of the claims process. make coverage determinations and request appropriate investigation to facilitate proper handling of files

Forward NF1, NF2 Forms upon receiving a new No-Fault claim

Make immediate contact with the applicant, or his representative to gather information necessary to the adjustment of the claim

Index all No-Fault applicants (ISO), record and monitor responses

Maintain a diary of all files assigned to the adjuster

Review all No-Fault communications received on assigned files

Review and monitor files for closing

Review all medical and expense bills submitted for duplication, and issue payment as appropriate

Follow HIC’s No-Fault Vendor procedures for the initiation of independent medical examinations

Medically manage through the proper use of ime and peer reviews as well as proper requests for verification

Request six month eobs and review and document files with action plans and injury and medical status