Analyze reported lower - level general liability claims for Sedgwick. Ensure ongoing adjudication of claims within company standards and industry best practices while working in a hybrid schedule.
About the role
- Claims Representative II managing PIP claims for auto insurance. Investigating and settling claims while ensuring compliance with state laws and documentation of decisions.
Responsibilities
- Drive efficient PIP claim resolutions by investigating, evaluating, and settling auto insurance claims for medical coverage and compliance with state laws
- Verifying that coverage exists
- Investigating and gathering information about injuries from auto accidents
- Determining qualification for benefits
- Documenting all decisions, correspondences, reports and discussions
- Assisting with litigation support including depositions and interrogatories
Requirements
- Bachelor’s Degree or equivalent experience
- 1 or more years of related work experience
- Knowledge of insurance policies and coverage, claim payment procedures, and familiarity with medical terminology
- Able to make sound decisions while using good judgment in evaluating claims
- Able to review and interpret complex and detailed documents such as contracts, medical reports and insurance regulations
- Effective oral and written communication skills
- Able to maintain confidential information
- Personal computer and math skill beneficial
- Ability to pass the required coursework applicable to the job duties
Benefits
- Flexibility through a scheduled Hybrid work model
- In-office workspace and materials for home office
- 401(K) plan with a dollar for dollar match on your first eight percent, plus immediate vesting
- Continue education and career development through Sentry University (SentryU)
- Tuition Reimbursement program
- Generous Paid-Time Off plan
- Volunteer-Time off
- Group Medical, Dental, Vision, Life insurance
- Parental leave
- Health and Wellness benefits
- Well-being and Employee Assistance programs
- Sentry Foundation gift matching program
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
Claims Examiner for Sedgwick adjudicating complex workers' compensation claims within service expectations. Join a company recognized for its caring culture and work - life balance.
Claims Representative using claims systems to manage diary and handle auto claims. Conducting investigations, confirming coverage, and negotiating settlements with various stakeholders.
Senior Workers' Compensation Claims Adjuster handling loss time claims across jurisdictions. Working primarily in California and managing investigations and litigation.
Claims Adjuster managing and processing claims related to windshield repair and replacement. Interacting with customers and coordinating with repair facilities for efficient claims handling.
Medical Claims Examiner processing healthcare claims for Imagenet. Ensuring compliance and accuracy in claims adjudication and processing.
Claims Examiner adjudicating complex workers' compensation claims at Sedgwick. Analyzing claims, negotiating settlements, and managing resolutions for clients in various industries.
Field Claims Specialist inspecting large and complex property claims for Intact, providing customer service and conducting investigations on - site. Collaborating with various teams and adhering to company standards.
Claims intern role at Auto - Owners Insurance investigating policy coverage and assessing loss amounts. Assisting claims resolution and ensuring accurate payments while studying insurance policies.
Claims Specialist providing exceptional service managing complex medical stop loss claims at QBE. Collaborating with stakeholders and maintaining client relationships while ensuring compliance and strategy implementation.