Description
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.
The primary purpose of this role is to investigate, negotiate, and resolve personal injury protection (PIP) and medical payments (Med Pay) claims in accordance with policy provisions, best practices, and jurisdictional requirements.
Key Responsibilities:
- Manage claims and adjust moderately complex to complex PIP/Med Pay claims across multiple jurisdictions, with a focus on New Jersey claims experience
- Investigate loss details, evaluate, negotiate, and resolve claims within appropriate authority guidelines
- Review assigned files and claim instructions for proper claim handling, establish reserves, and issue payments based on claim details and damages
- Clearly document thought process, investigation, evaluation, negotiation, and settlement decisions
- Prioritize assigned claims workload to keep policyholders and other involved parties informed and provide timely claims status updates
- Serve as a subject matter expert on state laws, regulations, statutes, and procedures to ensure proper handling of assigned claims
- Deliver best-in-class claim service through proactive communications with customers, brokers, and other claim professionals
- Work independently within significant limits and authority on assignments of higher technical complexity and coordination
- Identify possibly suspicious claims, take recorded statements, and make coverage decisions on complex claims
Qualifications:
- Six years of related experience, including three years of PIP/Med Pay adjusting experience, or equivalent combination of education and experience
- Bachelor's degree from an accredited college or university preferred
- Professional certification as applicable to line of business preferred
- Secure and maintain State adjusting licenses as required for the position
Benefits:
- Flexible work schedule
- Referral incentive program
- Career development and promotional growth opportunities
- Comprehensive benefits package, including medical, dental, vision, 401K, and matching
Work Environment Requirements:
- Physical: Computer keyboarding
- Auditory/Visual: Hearing, vision, and talking
- Mental: Clear and conceptual thinking ability, excellent judgment and discretion, ability to meet deadlines