Remote PIP Claims Specialist (NJ) — Growth & Flexible Hours

Sedgwick; Lincoln (NE); Remote; USD 75,000 - 85,000; Full time

Benefits offered by this job

Flexible work schedule

Referral incentive program

Career development opportunities

Comprehensive benefits package

Job summary

Sedgwick is seeking a Claims Examiner to handle PIP/Med Pay claims with NJ exposure, while supporting a US telecommuter model. You will investigate, negotiate, and resolve claims with adherence to policy provisions and jurisdictional rules.

You’ll document thought processes, adjust reserves, and provide timely status updates, serving as a subject matter expert on state laws and procedures. A strong background in PIP/Med Pay is required.

Qualifications

• Six years of related experience, to include three years of PIP/Med pay adjusting experience
• Bachelor's degree from an accredited college or university preferred
• Professional certification and state licenses where required

Responsibilities

• Manages PIP/Med Pay claims across multiple jurisdictions; NJ experience required
• Investigates, negotiates, and resolves claims within authority guidelines
• Reviews files, establishes reserves, and issues payments based on claim details
• Documents thought process, investigation, evaluation, negotiation, and settlements
• Prioritizes workload and provides timely claims status updates
• Serves as SME on state laws, regulations, and procedures
• Delivers best-in-class claim service with proactive communications
• Works independently on higher-complexity assignments
• Identifies suspicious claims and takes recorded statements
• Identifies coverage decisions on complex claims

Skills

PIP/Med Pay adjusting

Claims handling

Negotiation

Education

Bachelor's degree preferred

Professional certification preferred

Job description

Sedgwick is seeking a Claims Examiner to handle PIP/Med Pay claims with NJ exposure, while supporting a US telecommuter model. You will investigate, negotiate, and resolve claims with adherence to policy provisions and jurisdictional rules.

You’ll document thought processes, adjust reserves, and provide timely status updates, serving as a subject matter expert on state laws and procedures. A strong background in PIP/Med Pay is required.