Remote Auto Claims Adjuster (PIP) – NY Licensed

Sedgwick Claims Management Services Inc.; Seven Hills (OH); Remote; USD 55,000 - 60,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401k matching

PTO

Disability insurance

Life insurance

Flexible spending or HSA

Job summary

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.

Qualifications

• 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.

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 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.

Skills

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

Education

Bachelor's degree

Tools

Microsoft Office

Job description

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.