Claims Representative, Auto | PIP | Remote | NY Lic

Sedgwick; City of Rochester (NY); Remote; USD 55.000 - 60.000; Vollzeit

Benefits dieser Stelle

Medical insurance

Dental insurance

Vision insurance

401k with match

PTO

Zusammenfassung

Sedgwick is seeking an experienced claims adjuster to evaluate auto claims, manage first-party medical treatment, and determine eligibility under PIP/medical payment benefits. The role requires review of medical records, policy interpretation, and effective communication with clients, providers, and attorneys.

Three years in PIP/medical payments or workers' compensation is preferred; a Bachelor's degree and active state adjuster licenses are required.

Qualifikationen

• Bachelor's degree preferred; State adjuster licenses required.
• 3 years of Personal Injury Protection (PIP), medical payments and/or workers' compensation experience.
• Experience with BI/Casualty adjusting and good negotiation skills.

Aufgaben

• Review claims to determine nature of medical loss and provide coverage explanations.
• Interpret policy language to make coverage decisions for 1st party medical coverage.
• Assess medical treatment, evaluate medical bills, and review potential fraud investigations.
• Identify claim exposures and establish or adjust reserves.
• Document all claim activity and communicate with clients and providers.

Kenntnisse

Medical terminology

Bodily Injury adjusting

Oral and written communication

Detail oriented

Microsoft Office

Negotiation skills

Interpersonal skills

Organization skills

Time management

Independent and team

Performance competencies

Ausbildung

Bachelor's degree

State adjuster licenses required

Tools

Microsoft Office

Jobbeschreibung

Seven Hills, OH

Telecommuter FL

Telecommuter OH

Telecommuter WI

Telecommuter NY

Telecommuter NJ

Full time

R80462

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

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 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.
• Supports the organization's quality program(s).

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
• Detailed 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

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