Claims Representative, Auto | PIP | Remote

By joining Sedgwick, you'll be part of something truly meaningful. Itu2019s 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, thereu2019s no limit to what you can achieve. Newsweek Recognizes Sedgwick as Americau2019s Greatest Workplaces National Top Companies Certified as a Great Place to Worku00ae Fortune Best Workplaces in Financial Services & Insurance Claims Representative, Auto PIP Remote PRIMARY PURPOSE : 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 FUNCTIONS and RESPONSIBILITIES u2022 Reviews claims to determine the nature of the medical loss and provides explanation of coverage. u2022 Researches policy contract and interprets policy language to make coverage decisions based on 1st party medical coverage. u2022 Assesses medical treatment, evaluates medical bills, and initiates or reviews potential fraud investigations. u2022 Interprets medical records regarding injuries and addresses ongoing and continuous treatment for claimant. u2022 Identifies claim exposures and establishes reserves or adjust reserves accordingly on assigned files. u2022 Ensures claim files are properly documented and correctly coded based on the policy. u2022 Documents all claim activity and workflow accurately throughout the life of the claim in accordance with standard operating procedures. u2022 Provides effective and timely communication to client, claimants, medical providers, attorney offices, and vendors. u2022 Negotiates resolution of claims and makes payments within authority. ADDITIONAL FUNCTIONS and RESPONSIBILITIES u2022 Performs other duties as assigned. u2022 Supports the organization's quality program(s). u2022 Travels as required. 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 u2022 Knowledge of medical terminology and appropriate application of deductibles and limits u2022 Familiarity with Bodily Injury (BI)/Casualty adjusting u2022 Oral and written communication skills u2022 Detailed oriented u2022 PC literate, including Microsoft Office products u2022 Strong negotiation skills u2022 Good interpersonal and customer skills u2022 Good organization skills u2022 Good time management skills with the ability to multi-task u2022 Ability to work independently and in a team environment u2022 Ability to meet or exceed Performance Competencies WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations. Mental : Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical : Computer keyboarding, travel as required Auditory/Visual : Hearing, vision and talking _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_ _$50,000-$55,000_ _. 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._ 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. 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. Sedgwick is the worldu2019s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The companyu2019s 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. For more, see

Created: 2026-02-04