Remote PIP Claims Examiner – NJ Expert

Sedgwick; Boise (ID); Remote; USD 75,000 - 85,000; Full time

Benefits offered by this job

Flexible schedule

Referral incentives

Career development

Comprehensive benefits

Job summary

Sedgwick is hiring a Claims Examiner to investigate and resolve PIP and Med Pay claims. The role focuses on NJ experience, complex claims handling, and adherence to policy provisions and jurisdictional requirements.

The position emphasizes inputting claim data, guiding insureds through the claims process, and delivering proactive communications with customers and brokers in a high-volume environment.

Qualifications

• Six years of related experience, including three years of PIP/Med Pay adjusting.
• Bachelor's degree from an accredited college or university preferred.
• Professional certification and state adjusting licenses preferred / required to be secured and maintained.

Responsibilities

• Manages PIP/Med Pay claims across multiple jurisdictions; NJ experience required.
• Investigates, negotiates, and resolves claims within authority guidelines; maintains productivity and customer service.
• Reviews files and instructions; establishes reserves and issues payments per claim details and damages.
• Documents thought process, investigation, evaluation, negotiation, and settlement decisions clearly.
• Prioritizes assigned claims workload and provides timely status updates to policyholders and others.
• Serves as a subject matter expert on state laws, regulations, and procedures for assigned claims.
• Delivers best-in-class claim service with proactive communications to customers, brokers, and other professionals.
• Works independently on high-technical-complexity assignments and coordination.
• Identifies possibly suspicious claims and takes recorded statements.
• Identifies, confirms, and makes coverage decisions on complex claims.

Skills

PIP/Med Pay adjusting

Claims investigation

Negotiation

Regulatory knowledge

Education

Bachelor's degree preferred

Professional certification preferred

State adjusting licenses required

Job description

Sedgwick is hiring a Claims Examiner to investigate and resolve PIP and Med Pay claims. The role focuses on NJ experience, complex claims handling, and adherence to policy provisions and jurisdictional requirements.

The position emphasizes inputting claim data, guiding insureds through the claims process, and delivering proactive communications with customers and brokers in a high-volume environment.