Remote PIP/Med Pay Claims Examiner (NJ)

Sedgwick; Juneau (AK); Remote; USD 75,000 - 85,000; Full time

Benefits offered by this job

Flexible schedule

Referral incentive

Career development

Full benefits

Job summary

Sedgwick is hiring a Claims Examiner specialized in PIP/Med Pay to investigate, negotiate, and resolve claims across jurisdictions, with a focus on New Jersey. You will input claim data and guide insureds and claimants through the process.

Requires six years of related experience, including three years in PIP/Med Pay; a Bachelor's degree is preferred and state licenses must be secured. Flexible work options and comprehensive benefits are offered.

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.
• Bachelor's degree from an accredited college or university preferred.
• Professional certification as applicable to line of business 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 adjusting

Negotiation

Investigation

Communication

Policy interpretation

Education

Bachelor's degree preferred

Professional certification

State adjusting licenses required

Tools

Claims processing software

Regulatory guidelines knowledge

Job description

Sedgwick is hiring a Claims Examiner specialized in PIP/Med Pay to investigate, negotiate, and resolve claims across jurisdictions, with a focus on New Jersey. You will input claim data and guide insureds and claimants through the process.

Requires six years of related experience, including three years in PIP/Med Pay; a Bachelor's degree is preferred and state licenses must be secured. Flexible work options and comprehensive benefits are offered.