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Medical Payment Adjuster

Medical Payment Adjuster Think that working in the insurance field can’t be ex

Position: Payment Adjuster Salary: $42,200 per year Type: Full Time Location: Houston, TX
Think that working in the insurance field can’t be exciting, rewarding and challenging? Think again. You’ll help us reinvent
protection and retirement to improve customers’ lives. We’ll help you make an impact with our training and mentoring
offerings. Here, you’ll have the opportunity to expand and apply your skills in ways you never thought possible. And you’ll
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
Allstate Insurance Company has an exceptional career opportunity for a Medical Payment Adjuster located in north west
Houston, TX!
The Medical Payment Adjuster is responsible for handling the medical portion of auto accident claims for the insured or
other injured parties found to be eligible under personal injury protection and/or medical payment benefits where the
policy limits or exposure to the company is limited. 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 gaining
experience in delivering compassionate service that is fast, fair, and easy, to ensure customer retention. At this level, the
individual typically settles minor or smaller claims, such as claims in less regulated states (or on some ocassions more
complex claims with guidance as needed). The individual is gaining experience in delivering compassionate service that is
fast, fair, and easy, to ensure customer retention. The individual is capable of working independently, prioritizing the
individual’s own responsibilities, and managing the individual’s own workload.
Key Responsibilities:
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
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 in determining 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
Investigates, reviews and accepts or rejects coverage and other potential coverage
Determines appropriate benefit and settles basic claims, including resolution of basic usual and customary billings
Monitors treatment and benefit payments for excessive, unreasonable, or abusive claims
Compensation and other important information:
Starting salary: $42,200 annually (paid bi-weekly)
Must be available to work a scheduled shift Monday - Friday between the hours of 7:00am - 7:30pm with ocassional
Notice of Licensing Requirement
As a condition of your employment, you may be expected to comply with the state specific licensing process and
requirements to perform work as a Medical Payment Adjuster. Failure to complete these requirements within the time
frame designated by the hiring department may result in the termination of your employment with Allstate Insurance
Job Qualifications
Bachelors degree preferred
At least 2 years of customer service experience in an office environment
Experienced with handling heavy call volume
Interact effectively with internal or external customers and act with empathy
Ability to investigate, evaluate, negotiate and settle basic claims
Knowledge of claim processes, policies, procedures, claim systems, coverage, liability, damage estimating, and/or
settlement, and adherence to applicable legal compliance standards
Ability to apply industry knowledge to discipline practices, including best practices, to support the business unit
Ability to leverage learned technical skills in support of team objectives
Conflict management and problem resolution skills in managing internal and external customer relationships
Provides individual decision making within authority limits
Bilingual candidates strongly encouraged to apply
Prior Military are encouraged to apply
Has and maintains all appropriate licenses and registrations for the role per state requirements
The candidate(s) offered this position will be required to submit to a background investigation, which includes a drug
Good Work. Good Life. Good Hands®.
As a Fortune 100 company and industry leader, we provide a competitive salary - but that’s 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, you’ll have access to a wide variety of programs to help you balance your work and personal life -- including a
generous paid time off policy.
Learn more about life at Allstate. Connect with us on , , and or watch a .
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.
For jobs in San Francisco, please click for information regarding the San Francisco Fair Chance Ordinance.
For jobs in Los Angeles, please click for information regarding the Los Angeles Fair Chance Initiative for Hiring Ordinance.
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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