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

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 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.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE:

• 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.

• 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 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 $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. 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.  Management retains the discretion to add or to change the duties of the position at any time.

at any time.

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.