Claims Examiner | PIP | Lit Required | New Jersey Claims

Sedgwick; Boise (ID); Remote; USD 75,000 - 85,000; Full time

Benefits offered by this job

Flexible schedule

Referral incentives

Career development

Comprehensive benefits

Job summary

Sedgwick is hiring a Claims Examiner to investigate and resolve PIP and Med Pay claims. The role focuses on NJ experience, complex claims handling, and adherence to policy provisions and jurisdictional requirements.

The position emphasizes inputting claim data, guiding insureds through the claims process, and delivering proactive communications with customers and brokers in a high-volume environment.

Qualifications

• Six years of related experience, including three years of PIP/Med Pay adjusting.
• Bachelor's degree from an accredited college or university preferred.
• Professional certification and state adjusting licenses preferred / required to be secured and maintained.

Responsibilities

• Manages PIP/Med Pay claims across multiple jurisdictions; NJ experience required.
• Investigates, negotiates, and resolves claims within authority guidelines; maintains productivity and customer service.
• Reviews files and instructions; establishes reserves and issues payments per claim details and damages.
• Documents thought process, investigation, evaluation, negotiation, and settlement decisions clearly.
• Prioritizes assigned claims workload and provides timely status updates to policyholders and others.
• Serves as a subject matter expert on state laws, regulations, and procedures for assigned claims.
• Delivers best-in-class claim service with proactive communications to customers, brokers, and other professionals.
• Works independently on high-technical-complexity assignments and coordination.
• Identifies possibly suspicious claims and takes recorded statements.
• Identifies, confirms, and makes coverage decisions on complex claims.

Skills

PIP/Med Pay adjusting

Claims investigation

Negotiation

Regulatory knowledge

Education

Bachelor's degree preferred

Professional certification preferred

State adjusting licenses required

Job description

US Telecommuter

R73163

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 Examiner | PIP | Lit Required | New Jersey Claims

PRIMARY PURPOSE OF THE ROLE : Investigates, negotiates, and resolves personal injury protection (PIP) and medical payments (Med Pay) claims in accordance with policy provisions, best practices, and jurisdictional requirements. Responsible for the input of claim data and guiding insureds and claimants through the claim process and options.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE:

• Manages claims and adjusts moderately complex to complex, PIP/Med Pay, claims across multiple jurisdictions- must have New Jersey claims experience.

• Investigates loss details, evaluates, negotiates, and resolves claims within appropriate authority guidelines; maintains a high level of productivity, confidentiality, and customer service.

• Reviews assigned files and claim instructions for proper claim handling, establishes reserves and issues payment based on claim details and claim damages.

• Clearly documents thought process, investigation, evaluation, negotiation, and settlement decisions.

• Prioritizes assigned claims workload to keep policyholders and other involved parties informed and provides timely claims status updates.

• Serves as a subject matter expert on of state laws, regulations, statutes, and procedures to ensure proper handling of assigned claims.

• Delivers best in class claim service through setting appropriate expectation proactive communications with customers, brokers, and other claim professionals throughout the claims process.

• Works independently within significant limits and authority on assignments of higher technical complexity and coordination.

• Identifies possibly suspicious claims.

• Takes recorded statements.

• Identifies, confirms, and makes coverage decisions on complex claims.

QUALIFICATIONS

Education & Licensing: Six (6) years of related experience, to include three (3) years of PIP/Med pay adjusting experience, or equivalent combination of education and experience required.

• Bachelor's degree from an accredited college or university preferred.

• Professional certification as applicable to line of business preferred.

• Secure and maintain the State adjusting licenses as required for the position.

TAKING CARE OF YOU

• Flexible work schedule.

• Referral incentive program.

• Career development and promotional growth opportunities.

• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Work environment requirements include –

Physical: Computer keyboarding

Auditory/visual: Hearing, vision and talking

Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

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 $75,000 to $85,000. 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.

at any time.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

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