Claims Representative, Auto – PIP

🔥 17 hours ago

🐊 Florida, New Jersey, +4 more states – Remote

🐊 Florida – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🍂 Massachusetts – Remote ⚓ Rhode Island – Remote 🤠 Texas – Remote

💵 $55k - $60k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Sedgwick

WebsiteLinkedInAll Job Openings

10,000+ employees

🏗️ Construction

💼 Consulting

🏥 Healthcare

Construction • Consulting • Healthcare

Sedgwick is a global provider of technology-enabled risk, benefits, and integrated business solutions. They help people and organizations by managing and mitigating risk with solutions in accident, health, disability, unemployment compensation, and liability claims administration, among others. Sedgwick offers services such as claims administration, building consulting, forensic accounting, and forensic engineering. Their specialties include property restoration, brand protection, and loss prevention across several industries, including agriculture, construction, and environmental sectors. The company emphasizes diversity, equity, and inclusion (DEI) as well as environmental, social, and governance (ESG) practices.

📋 Description

• Evaluate auto claims involving injured parties. • Manage first-party medical treatment to determine eligibility under personal injury protection and/or medical payment benefits. • Review claims to determine the nature of the medical loss and explain coverage. • Research policy contracts and interpret policy language to make coverage decisions based on first-party medical coverage. • Assess medical treatment, evaluate medical bills, and initiate or review potential fraud investigations. • Interpret medical records regarding injuries and address ongoing and continuous treatment for claimants. • Identify claim exposures and establish or adjust reserves on assigned files. • Ensure claim files are properly documented and correctly coded based on the policy. • Document all claim activity and workflow accurately throughout the life of the claim in accordance with standard operating procedures. • Communicate effectively and timely with clients, claimants, medical providers, attorney offices, and vendors. • Negotiate claim resolutions and make payments within authority. • Perform other duties as assigned.

🎯 Requirements

• Bachelor's degree from an accredited college or university preferred. • State adjuster licenses required. • Three (3) years of Personal Injury Protection (PIP), medical payment and/or workers compensation or equivalent combination of education and experience. • Knowledge of medical terminology and appropriate application of deductibles and limits. • Familiarity with Bodily Injury (BI)/Casualty adjusting. • Oral and written communication skills. • PC literacy, including Microsoft Office products. • Organizational skills required. • Computer keyboarding. • Hearing, vision and talking. • Clear and conceptual thinking ability. • Excellent judgement and discretion. • Ability to meet deadlines.

🏖️ Benefits

• Flexible work schedule. • Referral incentive program. • Career development and promotional growth opportunities. • Medical, dental, and vision benefits. • 401K on day one. • 401k matching. • PTO. • Disability and life insurance. • Employee assistance. • Flexible spending or health savings account. • Other additional voluntary benefits.