Liability Claim Adjuster

Fortune Best Workplaces in Financial Services & Insurance

Claims Representative, Auto | PIP

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.

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.

Bachelors degree from an accredited college or university preferred. 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.

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.

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.

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 worlds leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The companys 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.