Remote PIP/Med Pay Claims Examiner (NJ)

Sedgwick; Atlanta (GA); 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 seeking a Claims Examiner specializing in PIP and Med Pay to join our remote team. You will investigate, negotiate, and resolve complex claims across multiple jurisdictions, with an emphasis on New Jersey requirements.

You will input data accurately, guide insureds through the process, and exercise judgment on reserve and payment decisions. The role requires 6 years of related experience, including 3 years in PIP/Med Pay, and a preference for a Bachelor’s degree and state adjusting

Qualifications

• Six (6) years of related experience, including three (3) years in PIP/Med Pay adjusting.
• Bachelor's degree from an accredited college or university preferred.
• Professional certification applicable to line of business preferred.
• Secure and maintain state adjusting licenses as required.

Responsibilities

• Investigates, negotiates, and resolves PIP/Med Pay claims.
• Manages moderately complex to complex claims across jurisdictions, with NJ experience.
• Reviews files, establishes reserves, and issues payments.
• Documents thought process, investigation steps, and settlement decisions.
• Provides timely claims status updates to policyholders and others involved.
• Serves as SME on state laws, regulations, and procedures for claims handling.
• Delivers best-in-class service with proactive communications to customers and brokers.
• Works independently within authority on high-complexity assignments.
• Identifies potentially suspicious claims and takes statements.

Skills

PIP/Med Pay adjusting

Investigation

Customer service

Education

Bachelor's degree (preferred)

State adjusting licenses

Professional certification (preferred)

Job description

Sedgwick is seeking a Claims Examiner specializing in PIP and Med Pay to join our remote team. You will investigate, negotiate, and resolve complex claims across multiple jurisdictions, with an emphasis on New Jersey requirements.

You will input data accurately, guide insureds through the process, and exercise judgment on reserve and payment decisions. The role requires 6 years of related experience, including 3 years in PIP/Med Pay, and a preference for a Bachelor’s degree and state adjusting