Remote PIP & Med Pay Claims Examiner

Sedgwick; San Juan (PR); Remote; USD 75,000 - 85,000; Full time

Benefits offered by this job

Medical, dental, vision

401k with company matching

PTO

Life insurance

Job summary

Sedgwick is seeking a remote Claims Examiner for PIP/Med Pay in a US telecommuter role. You will investigate, negotiate, and resolve claims across jurisdictions, with New Jersey claims experience preferred.

Responsibilities include evaluating claims, documenting processes, and providing timely updates while upholding regulatory standards. A comprehensive benefits package and strong career growth await.

Qualifications

• Six (6) years of related experience, to include three (3) years of PIP/Med pay adjusting experience, or equivalent combination of education and experience required.
• Bachelor's degree preferred.
• Secure and maintain the State adjusting licenses as required for the position.

Responsibilities

• Manages claims and adjusts moderately complex to complex, PIP/Med Pay, claims across multiple jurisdictions- must have New Jersey claims experience.
• Investigates loss details, evaluates, negotiates, and resolves claims within appropriate authority guidelines; maintains a high level of productivity, confidentiality, and customer service.
• Reviews assigned files and claim instructions for proper claim handling, establishes reserves and issues payment based on claim details and claim damages.
• Clearly documents thought process, investigation, evaluation, negotiation, and settlement decisions.
• Prioritizes assigned claims workload to keep policyholders and other involved parties informed and provides timely claims status updates.
• Serves as a subject matter expert on of state laws, regulations, statutes, and procedures to ensure proper handling of assigned claims.
• Delivers best in class claim service through setting appropriate expectation proactive communications with customers, brokers, and other claim professionals throughout the claims process.
• Works independently within significant limits and authority on assignments of higher technical complexity and coordination.
• Identifies possibly suspicious claims.
• Takes recorded statements.
• Identifies, confirms, and makes coverage decisions on complex claims.

Skills

PIP/Med Pay experience

Claims adjusting

Negotiation

Regulatory knowledge

Communication

Education

Bachelor's degree preferred

State adjusting license

Professional certification

Job description

Sedgwick is seeking a remote Claims Examiner for PIP/Med Pay in a US telecommuter role. You will investigate, negotiate, and resolve claims across jurisdictions, with New Jersey claims experience preferred.

Responsibilities include evaluating claims, documenting processes, and providing timely updates while upholding regulatory standards. A comprehensive benefits package and strong career growth await.