Claims Examiner

Primary Purpose of the Role 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 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 state laws, regulations, statutes, and procedures to ensure proper handling of assigned claims. Delivers best-in-class claim service through setting appropriate expectations and 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. Qualifications Education & Licensing: 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. Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred. Secure and maintain the State adjusting licenses as required for the position. 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 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. The range of starting pay for this role is 75,000 to 85,000. 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. #J-18808-Ljbffr