Claims Representative Personal Injury Protection/Medical Payment

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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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Claims Representative Personal Injury Protection / Medical Payment PRIMARY PURPOSE : To evaluate auto claims involving injured parties and manage first party medical treatment to determine eligibility under a personal injury protection and / or medical payment benefits.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• 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. ADDITIONAL FUNCTIONS and RESPONSIBILITIES
• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required. 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

• Knowledge of medical terminology and appropriate application of deductibles and limits
• Familiarity with Bodily Injury (BI) / Casualty adjusting
• Oral and written communication skills
• Detailed oriented
• PC literate, including Microsoft Office products
• Strong negotiation skills
• Good interpersonal and customer skills
• Good organization skills
• Good time management skills with the ability to multi-task
• Ability to work independently and 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 talkingThe 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 $55,000.00. 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.