Florida Auto PIP / Medical Payments Adjuster

Job Details: Job Location: Loyalty MGA LLC

• Miami, FL, Salary Range: $45000.00 - $65000.00Salary/year, 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 Qualifications: Qualifications: Some Florida PIP or Medical Payments claims handling experience Some knowledge of Florida PIP statutes and fee schedules Experience reviewing medical bills and medical documentation Excellent organizational and time management skills Strong bilingual written and verbal communication skills Ability to work independently and manage a high-volume caseload Claims system experience preferred Preferred: Florida Adjuster License (620 or equivalent) Experience with medical payments, excel and/or medical coding