Position summary

Responsibilities

• Train new hires on PIP Coverage & Qualification and Medical Management processes, including Fast Track workflows, systems and performance expectations.
• Cover PIP policies, coverage and qualification requirements, documentation, medical bill processing, payments, denials and KPIs.
• Reinforce classroom instruction with hands-on coaching and file reviews.
• Support each new hire for about the first 30 days, through the transition to production.
• Give supervisors weekly progress reports on each new hire's strengths and development areas.
• Confirm new hires understand productivity, quality, diary, inventory and timeliness expectations before moving to the floor.

• Plan, develop and lead recurring refresher training sessions for PIP staff.
• Use QA findings, Target Reviews, file reviews, audits and claim trends to set training priorities.
• Deliver training on recurring errors, policy requirements, and new or revised processes and systems.
• Partner with supervisors to identify individual, team and department-wide training needs.
• Keep training materials accurate and current and evaluate training effectiveness.

• Conduct assigned Target Reviews of claim handling, documentation, timeliness and adherence to PIP standards.
• Give objective, constructive and actionable feedback, and document findings in the performance management platform.
• Help supervisors distinguish knowledge gaps, process issues and ongoing performance concerns.
• Recommend targeted coaching, additional training or follow-up reviews.
• Provide one-on-one or small-group training when recurring issues appear and follow up to confirm improvement.
• Escalate significant or recurring concerns to management.

• Provide temporary supervisor and adjuster coverage within assigned authority.
• Review and approve coverage decisions and payments within assigned authority, escalating complex issues.
• Conduct inventory sweeps for aging claims, pending decisions, overdue diaries and outstanding activities.
• Review PEER reports and adjust medical bills as appropriate (pay, reduce, deny or escalate).
• Work outstanding medical bills and urgent claims to prevent delays, interest and inventory buildup.
• Support C&Q, C&Q FT, MM and MM FT units and help supervisors balance workload.
• Perform other PIP claim-handling duties as assigned.

Qualifications

• 3-5 years of PIP claims experience, including Coverage & Qualification and Medical Management.
• Active [State] adjuster license (for Florida: 2-20 All-Lines)
• Strong technical knowledge of PIP coverage, qualification, medical bill processing and payments.
• Experience reviewing claims and identifying errors, trends and improvement opportunities.
• Effective communication, facilitation and coaching skills.
• Ability to give objective feedback and address performance concerns professionally.
• Strong analytical skills and attention to detail.
• Sound judgment and the ability to make decisions within established authority.
• Ability to work independently, manage competing priorities and move between trainer, reviewer and adjuster duties.

• Experience as a trainer, mentor, lead adjuster or acting supervisor.
• Working knowledge of medical bill review, fee schedules and PEER review.