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.
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Claims Representative, Auto | PIPPRIMARY 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.
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.
TAKING CARE OF YOU
Flexible work schedule.
Referral incentive program.
Career development and promotional growth opportunities.
A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
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.
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.Skills Required
- State adjuster licenses
- Three years of Personal Injury Protection (PIP), medical payment, or workers compensation experience
- 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
- Bachelor's degree from an accredited college or university
- Nursing experience
Sedgwick Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Sedgwick and has not been reviewed or approved by Sedgwick.
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Leave & Time Off Breadth — Generous paid time off and paid holidays are emphasized, with PTO accruals increasing with tenure. Paid parental leave and caregiver support further expand time-off coverage.
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Healthcare Strength — Medical, dental and vision coverage is complemented by telemedicine and a personal health concierge. Wellbeing supports such as diabetes and weight-management programs, fertility services, and robust mental-health access (coaching, therapy, psychiatry) broaden care.
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Parental & Family Support — Paid parental leave and caregiver support are offered alongside family-forming resources. Fertility services and adoption assistance reinforce family-oriented benefits.
Sedgwick Insights
What We Do
From our modest beginnings as a regional claims administrator, Sedgwick has grown into a leading global provider of technology-enabled risk, benefits and integrated business solutions with 31,000+ colleagues, located across 80 countries. Through innovative product development, organic business development and strategic acquisitions, Sedgwick’s offerings continue to evolve beyond claims processing to meet the current and future needs of our clients. Our approach to delivering quality service in areas such as workers’ compensation, liability, property, disability and absence management goes far beyond just managing claims—we aim to simplify the process and reduce complexity, making it easy and effective for everyone involve.
Why Work With Us
We stay tuned into what our colleagues want and need and deliver a world-class colleague experience that demonstrates how much we value their unique contributions to our business. You’ll see and feel what it’s like to work for a company that’s committed to doing the right thing – for those we serve, for our planet and for each other.
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