No-Fault/PIP/NJ SAIP Injury Examiner

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring.

It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day.

It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career.

And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve.

If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here.

Join us and contribute to Sedgwick being a great place to work.

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No-Fault / PIP / NJ SAIP Injury Examiner

PRIMARY PURPOSE : Investigates, negotiates, and resolves personal injury protection (PIP) and medical payments (Med Pay) claims in accordance with policy provisions, best practices, and jurisdictional requirements.

Responsible for the input of claim data and guiding insureds and claimants through the claim process and options.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Manages claims and adjusts moderately complex to complex, PIP / Med Pay, claims across multiple jurisdictions.
• 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.
• Supports team members to resolve issues and identify appropriate matters for escalation.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Travel as required

QUALIFICATIONS

Education & Licensing

Bachelor's degree from an accredited college or university preferred. Licenses as required.

Experience

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.

Skills & Knowledge

• Deep knowledge and understanding of the auto claims contract as well as application of case law, state laws and regulations
• Ability to interface with internal and external customers in a pleasant manner on an ongoing basis
• Ability to maintain discretion in business relationships and exercise sound business judgement
• Excellent oral and written communication skills, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Excellent interpersonal skills
• Excellent negotiating skills
• Ability to create and complete comprehensive, accurate and constructive written reports
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental : Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion;

ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical : Computer keyboarding, travel as required

Auditory / Visual : Hearing, vision and talking

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description.

They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Pay Transparency :

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 60,250.00 . 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.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.

You may be just the right candidate for this or other roles.