Claims Representative, Auto | PIP | Remote | NY Lic

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.

The primary purpose of this role is to evaluate auto claims involving injured parties and manage first-party medical treatment to determine eligibility under personal injury protection and/or medical payment benefits.

Responsibilities:

• Review claims to determine the nature of medical loss and provide explanations of 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 reserves or adjust reserves accordingly on assigned files
• Ensure claim files are properly documented and correctly coded based on policy
• Document all claim activity and workflow accurately throughout the life of the claim
• Provide effective and timely communication to clients, claimants, medical providers, attorney offices, and vendors
• Negotiate resolution of claims and make payments within authority

Qualifications:

• Bachelor's degree from an accredited college or university preferred
• State adjuster licenses required
• Three years of Personal Injury Protection (PIP), medical payment, and/or workers compensation or equivalent combination of education and experience; nursing experience a plus

Skills & Knowledge:

• Knowledge of medical terminology and application of deductibles and limits
• Familiarity with Bodily Injury (BI)/Casualty adjusting
• Oral and written communication skills
• Detail-oriented
• PC literate, including Microsoft Office products
• Strong negotiation skills
• Good interpersonal and customer skills
• Good organization skills
• Good time management skills with the ability to multi-task
• Ability to work independently and in a team environment

Work Environment:

• When applicable and appropriate, consideration will be given to reasonable accommodations

Benefits:

• Comprehensive benefits package, including medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits

The salary range for this role is $55,000-$60,000.