Remote Auto Claims Specialist - PIP & Medical

Sedgwick; Milwaukee (WI); Remote; USD 55,000 - 60,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401k with matching

PTO

Disability insurance

Life insurance

Employee assistance program

FSAs/HSA

Job summary

Sedgwick is hiring for a remote senior claims adjuster focused on auto PIP and medical payments. You will evaluate medical treatments, interpret policy language, and determine coverage, while maintaining accurate documentation and reserves. Strong negotiation and communication skills are essential.

Three years of PIP/medical or workers' compensation experience is preferred. State adjuster licenses are required. A Bachelor's degree is preferred, with Medicare/BI knowledge advantageous.

Qualifications

• Bachelor's degree preferred; state adjuster licenses required.
• Three years of Personal Injury Protection (PIP), medical payment and/or workers' compensation experience or equivalent.
• Knowledge of medical terminology and application of deductibles and limits.
• Familiarity with Bodily Injury (BI)/Casualty adjusting.
• Excellent oral and written communication, detail orientation, and organizational skills.

Responsibilities

• Evaluate auto claims involving injured parties and manage first-party medical treatment to determine eligibility under PIP/medical payments.
• Review claims, interpret policy language, and make coverage decisions based on first-party medical coverage.
• Assess medical treatment, review bills, and initiate or review fraud investigations.
• Interpret medical records, monitor ongoing treatment, and address claimant needs.
• Identify claim exposures and establish or adjust reserves.
• Document all claim activity and ensure proper coding and SOP compliance.
• Communicate effectively with clients, claimants, providers, attorneys, and vendors.
• Negotiate resolutions and make payments within authority.
• Support quality programs and perform other duties as assigned.

Skills

Medical terminology

BI/Casualty adjusting

Oral and written communication

Detail oriented

Microsoft Office

Negotiation skills

Interpersonal skills

Organizational skills

Time management

Team environment

Education

Bachelor's degree

State adjuster licenses

Tools

Microsoft Office

Job description

Sedgwick is hiring for a remote senior claims adjuster focused on auto PIP and medical payments. You will evaluate medical treatments, interpret policy language, and determine coverage, while maintaining accurate documentation and reserves. Strong negotiation and communication skills are essential.

Three years of PIP/medical or workers' compensation experience is preferred. State adjuster licenses are required. A Bachelor's degree is preferred, with Medicare/BI knowledge advantageous.