Claims Representative, Auto | PIP

Sedgwick; Kentucky; On-site; USD 60,000 - 65,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401K (on day one)

Paid time off (PTO)

Job summary

Sedgwick is hiring a Claims Representative for Auto and Personal Injury Protection (PIP). The role involves evaluating auto claims, reviewing medical treatments, and determining eligibility under PIP/medical payment benefits.

You will analyze medical records, interpret policy language, and coordinate with providers, clients, and attorneys to resolve claims efficiently. Requirements include a Bachelor’s degree (preferred), a state adjuster license, and at least three years of PIP/medical or

Qualifications

• Bachelor's degree preferred; state adjuster licenses required.
• Three years of Personal Injury Protection (PIP), medical payment and/or workers' compensation experience or equivalent.
• Knowledge of medical terminology and policy application for deductibles and limits.

Responsibilities

• Review claims to determine medical loss and explain coverage.
• Interpret policy language to make coverage decisions on 1st party medical coverage.
• Assess medical treatment, review bills, and flag potential fraud.
• Review medical records and ongoing treatment for claimants.
• Identify claim exposures and establish reserves.
• Document claim activity and code correctly per SOPs.
• Communicate with clients, claimants, providers, attorneys, and vendors.
• Negotiate settlements within authority and provide timely payouts.

Skills

Medical terminology

Oral & written communication

BI/Casualty adjusting

MS Office

Policy interpretation

Education

Bachelor's degree

State adjuster license

Tools

Microsoft Office

Job 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. 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, Auto | PIP

PRIMARY PURPOSE OF THE ROLE:

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 Responsibilities May Include

• 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 coverage.
• Assesses medical treatment, evaluates medical bills, and initiates or reviews potential fraud investigations.
• Interprets medical records regarding injuries and addresses ongoing and continuous treatment for claimant.
• Identifies claim exposures and establishes reserves or adjust reserves accordingly on assigned files.
• Ensures claim files are properly documented and correctly coded based on the policy.
• Documents all claim activity and workflow accurately throughout the life of the claim in accordance with standard operating procedures.
• Provides effective and timely communication to client, claimants, medical providers, attorney offices, and vendors.
• Negotiates resolution of claims and makes payments within authority.
• Performs other duties as assigned.

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 of medical terminology and appropriate application of deductibles and limits, familiarity with Bodily Injury (BI)/Casualty adjusting, oral and written communication skills, PC literate, including Microsoft Office products, and organizational skills required.

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 $60,000-$65,000. 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.

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.