Claims Representative, Auto | PIP | Remote | NY Lic

Sedgwick Claims Management Services Inc.; Seven Hills (OH); Remoto; USD 55.000 - 60.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical insurance

Dental insurance

Vision insurance

401k matching

PTO

Disability insurance

Life insurance

Flexible spending or HSA

Descrizione del lavoro

Sedgwick Claims Management Services is seeking a Claims Representative for auto, PIP and medical payments. You will review auto claims, determine coverage, and coordinate medical treatment while supporting first party benefits under NY licensing requirements.

Remote work option is available where allowed. Candidates should have a bachelor's degree, state adjuster license, and at least three years in PIP/medical or workers comp.

Competenze

• Bachelor's degree from an accredited college or university preferred.
• State adjuster licenses required.
• Three (3) years of PIP/medical payment and/or workers compensation or equivalent experience.

Mansioni

• 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 first-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 throughout the life of the claim per SOPs.
• Provides effective and timely communication to client, claimants, medical providers, attorney offices, and vendors.
• Negotiates resolution of claims and makes payments within authority.
• Supports the organization's quality programs.

Conoscenze

Knowledge of medical terminology

Bodily Injury adjusting

Oral and written communication

Detail oriented

MS Office proficiency

Negotiation skills

Interpersonal and customer skills

Organization skills

Time management

Independent and team work

Performance competencies

Formazione

Bachelor's degree

Strumenti

Microsoft Office

Descrizione del lavoro

Claims Representative, Auto | PIP | Remote | NY Lic

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.

Salary and Benefits

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.

• medical
• dental
• vision
• 401k and matching
• PTO
• disability and life insurance
• employee assistance
• flexible spending or health savings account
• 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, and 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.

Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.

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