Claims Representative, Auto, PIP

🔥 14 hours ago

🐊 Florida, New Jersey, +3 more states – Remote

🐊 Florida – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🏈 Ohio – Remote 🧀 Wisconsin – Remote

💵 $55k - $60k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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 and manage first party medical treatment to determine eligibility under personal injury protection and/or medical payment benefits • Review claims to determine the nature of medical loss and explain coverage • Research policy contracts and interpret policy language to make coverage decisions • Assess medical treatment, evaluate medical bills, and initiate or review potential fraud investigations • Interpret medical records regarding injuries and address ongoing and continuous treatment • Identify claim exposures and establish or adjust reserves • Ensure claim files are properly documented and correctly coded • Document claim activity and workflow throughout the life of the claim • Communicate with clients, claimants, medical providers, attorney offices, and vendors • Negotiate claim resolutions and make payments within authority • Support the organization's quality programs • Perform other assigned duties

🎯 Requirements

• 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 • Bachelor's degree from an accredited college or university preferred • Nursing experience a plus • Knowledge of medical terminology and appropriate application of deductibles and limits • Familiarity with Bodily Injury (BI)/Casualty adjusting • PC literate, including Microsoft Office products • Strong negotiation skills • Ability to meet or exceed Performance Competencies • Ability to work independently and in a team environment • Ability to meet deadlines and manage multiple priorities • Computer keyboarding; travel as required

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • 401k and matching • PTO • Disability insurance • Life insurance • Employee assistance • Flexible spending or health savings account • Other additional voluntary benefits • Reasonable accommodations when applicable and appropriate

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