Claims Processor - Administration

Fortune Best Workplaces in Financial Services & Insurance

Claims Examiner | No Fault- PIP | Lit Required | New York

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.

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.

Identifies possibly suspicious claims.

Identifies, confirms, and makes coverage decisions on complex claims.

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

Flexible work schedule.

Career development and promotional growth opportunities.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Computer keyboarding

Auditory/visual: 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. Always Accepting Applications.

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. Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.