Claims Representative, Auto | PIP

ESSENTIAL RESPONSIBLITIES MAY INCLUDE

• Reviews claims to determine the nature of the medical loss and provides explanation of coverage

•  Researches policy contract and interprets policy language to make coverage decisions based on 1st party medical coverage.

• Assesses medical treatment, evaluates medical bills, and initiates or reviews potential fraud investigations.

• Interprets medical records regarding injuries and addresses ongoing and continuous treatment for claimant.

• Identifies claim exposures and establishes reserves or adjust reserves accordingly on assigned files.

• Ensures claim files are properly documented and correctly coded based on the policy.

• Documents all claim activity and workflow accurately throughout the life of the claim in accordance with standard operating procedures.

• Provides effective and timely communication to client, claimants, medical providers, attorney offices, and vendors.

• Negotiates resolution of claims and makes payments within authority.

• Performs other duties as assigned.

QUALIFICATIONS

• Education & Licensing: Bachelor's degree from an accredited college or university preferred. State adjuster licenses required.

• Experience: Three (3) years of Personal Injury Protection (PIP), medical payment and/or workers compensation or equivalent combination of education and experience, nursing experience a plus.

• Skills: knowledge of medical terminology and appropriate application of deductibles and limits, familiarity with Bodily Injury (BI)/Casualty adjusting, oral and written communication skills, PC literate, including Microsoft Office products, and organizational skills required.

WORK ENVIRONMENT REQUIREMENTS INCLUDE
Physical: Computer keyboarding
Auditory/visual: Hearing, vision and talking
Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $60,000-$65,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.