Sedgwick
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.
Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Claims Representative, PIP | Auto | Remote PRIMARY PURPOSE : To evaluate auto claims involving injured parties and manage first party medical treatment to determine eligibility under a personal injury protection and/or medical payment benefits.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Reviews claims to determine the nature of the medical loss and provides explanation of coverage.
Researches policy contract and interprets policy language to make coverage decisions based on 1st party medical coverages.
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 claimant.
Identify claim exposures and establish reserves or adjust reserves accordingly 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.
Provide effective and timely communication to client, claimants, medical providers, attorney offices, and vendors.
Negotiate resolution of claims and make payments within authority.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Perform other duties as assigned.
Support the organization’s quality program(s).
Travel as required.
QUALIFICATIONS Education & Licensing Bachelor’s degree from an accredited college or university preferred. State adjuster licenses required.
Experience Three (3) 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 appropriate 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
Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
Physical Computer keyboarding, travel as required.
Auditory/Visual Hearing, vision and talking.
Compensation and Benefits As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $55,000- $60,000. A comprehensive benefits package is offered including but not limited to, 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 statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you’re excited about this role but your experience doesn’t align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com
#J-18808-Ljbffr
Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Claims Representative, PIP | Auto | Remote PRIMARY PURPOSE : To evaluate auto claims involving injured parties and manage first party medical treatment to determine eligibility under a personal injury protection and/or medical payment benefits.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Reviews claims to determine the nature of the medical loss and provides explanation of coverage.
Researches policy contract and interprets policy language to make coverage decisions based on 1st party medical coverages.
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 claimant.
Identify claim exposures and establish reserves or adjust reserves accordingly 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.
Provide effective and timely communication to client, claimants, medical providers, attorney offices, and vendors.
Negotiate resolution of claims and make payments within authority.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Perform other duties as assigned.
Support the organization’s quality program(s).
Travel as required.
QUALIFICATIONS Education & Licensing Bachelor’s degree from an accredited college or university preferred. State adjuster licenses required.
Experience Three (3) 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 appropriate 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
Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
Physical Computer keyboarding, travel as required.
Auditory/Visual Hearing, vision and talking.
Compensation and Benefits As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $55,000- $60,000. A comprehensive benefits package is offered including but not limited to, 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 statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you’re excited about this role but your experience doesn’t align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com
#J-18808-Ljbffr