Claims Representative, Auto | PIP | Remote

Sedgwick•Seven Hills, OH

3d•Remote

About The Position

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance. PRIMARY PURPOSE OF THE ROLE: 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.

Requirements

State adjuster licenses required.
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.
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
Computer keyboarding
Hearing, vision and talking
Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

Nice To Haves

Bachelor's degree from an accredited college or university preferred.
nursing experience a plus.

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.
Performs other duties as assigned.