Remote Auto Claims Specialist (PIP)

Sedgwick Claims Management Services Ltd; New York, Northern (NY, KY); Hybrid; USD 55,000 - 60,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Job summary

Sedgwick Claims Management Services Ltd is hiring a Claims Representative, Auto (PIP). This remote role focuses on evaluating auto claims, managing first-party medical treatment, and determining eligibility for PIP and medical payments.

You will work with clients, providers, and attorneys to resolve claims efficiently. You should bring at least three years of PIP or related experience, a Bachelor's degree (preferred) and active state adjuster licenses.

Qualifications

• Bachelor's degree preferred; state adjuster license required.
• Three years of PIP, medical payment, or workers' comp experience.
• Knowledge of medical terminology and policy language.

Responsibilities

• Reviews auto claims to determine medical loss and coverage.
• Assesses treatment and initiates or reviews fraud investigations.
• Interprets medical records and ongoing treatment for claimants.
• Identifies exposures and establishes reserves.
• Documents claim activity and codes files per SOP.
• Delivers timely communication to clients, providers, attorneys, and vendors.
• Negotiates settlements within authority and makes payments.

Skills

Medical terminology

Bodily Injury

Oral and written communication

Microsoft Office

Organizational skills

Education

Bachelor's degree preferred

State adjuster licenses required

Tools

Policy research software

Claims management CRM

Job description

Sedgwick Claims Management Services Ltd is hiring a Claims Representative, Auto (PIP). This remote role focuses on evaluating auto claims, managing first-party medical treatment, and determining eligibility for PIP and medical payments.

You will work with clients, providers, and attorneys to resolve claims efficiently. You should bring at least three years of PIP or related experience, a Bachelor's degree (preferred) and active state adjuster licenses.