Remote Auto Claims Specialist – PIP | NY Licensed

Sedgwick; Seven Hills (OH); Remote; USD 55,000 - 60,000; Full time

Job summary

Sedgwick in the United States is hiring a Claims Representative for Auto/PIP with remote options and NY license. You will evaluate auto claims, manage medical treatment, and determine eligibility for personal injury protection benefits.

You will review policy language, document activity, negotiate settlements within authority, and coordinate with clients, claimants, medical providers, and vendors. Strong communication, detail orientation, and multitasking are essential.

Qualifications

• 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.

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).

Skills

medical terminology

BI/Casualty adjusting

communication skills

attention to detail

MS Office

negotiation skills

interpersonal skills

organization

time management

independent/team work

performance competencies

Education

Bachelor's degree

State adjuster license

Job description

Sedgwick in the United States is hiring a Claims Representative for Auto/PIP with remote options and NY license. You will evaluate auto claims, manage medical treatment, and determine eligibility for personal injury protection benefits.

You will review policy language, document activity, negotiate settlements within authority, and coordinate with clients, claimants, medical providers, and vendors. Strong communication, detail orientation, and multitasking are essential.