Claims Representative, Auto – PIP

🔥 1 hour ago

🐊 Florida, New Jersey, +1 more states – Remote

🐊 Florida – Remote 🏖️ New Jersey – Remote 🏈 Ohio – Remote

💵 $60k - $65k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

🦅 H1B Visa Sponsor

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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 and evaluate medical bills • Initiate or review potential fraud investigations • Interpret medical records regarding injuries and address ongoing 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 claim lifecycle • Communicate with clients, claimants, medical providers, attorney offices, and vendors • Negotiate claim resolutions and make payments within authority • Perform other assigned duties

🎯 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 experience, or equivalent combination of education and experience • Nursing experience is a plus • Knowledge of medical terminology • Knowledge of 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 • Ability to perform computer keyboarding • Hearing, vision, and talking abilities • Clear and conceptual thinking ability • Excellent judgment and discretion • Ability to meet deadlines

🏖️ Benefits

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