Remote Auto Claims Advocate – PIP/Med Pay (NY Licensed)

Sedgwick; Seven Hills (OH); Remote; USD 55.000 - 60.000; Vollzeit

Benefits dieser Stelle

Medical

Dental

Vision

401k and matching

PTO

Disability and life insurance

Flexible spending or health savings

Zusammenfassung

Sedgwick is seeking a Claims Representative, Auto (PIP/Medical) to work remotely with NY license requirements. You will evaluate auto claims, review medical treatment, and determine coverage and reserves.

Strong negotiation, communication, and attention to detail are essential as you collaborate with clients, medical providers, attorneys, and vendors. The role emphasizes independent work within a team, adherence to SOPs, and participation in Sedgwick’s quality programs while offering a

Qualifikationen

• Bachelor’s degree preferred; state adjuster licenses required.
• 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 and well organized.
• PC literate, including Microsoft Office products.

Aufgaben

• Reviews claims to determine the nature of the medical loss and provides explanation of coverage.
• 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).

Kenntnisse

Medical terminology

Bodily Injury adjusting

Oral and written communication

Detail oriented

PC literate

Negotiation skills

Interpersonal skills

Organizational skills

Time management

Teamwork

Ausbildung

Bachelor's degree preferred

Tools

Microsoft Office

Jobbeschreibung

Sedgwick is seeking a Claims Representative, Auto (PIP/Medical) to work remotely with NY license requirements. You will evaluate auto claims, review medical treatment, and determine coverage and reserves.

Strong negotiation, communication, and attention to detail are essential as you collaborate with clients, medical providers, attorneys, and vendors. The role emphasizes independent work within a team, adherence to SOPs, and participation in Sedgwick’s quality programs while offering a