Claims Examiner | Auto NF, PIP, MP | Remote

Claims Examiner | Auto NF, PIP, MP | Remote

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. Newsweek recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance.

Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands? Enjoy flexibility and autonomy in your daily work, your location, and your career path. This role is open to a remote, telecommuter, work-at-home, or hybrid setting nationwide. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Access diverse and comprehensive benefits to take care of your mental, physical, financial, and professional needs.

Are You An Ideal Candidate?

As a Claims Examiner, you will primarily handle auto-related liability claims for the following lines of coverage : Auto Liability, No Fault (NF), Personal Injury Protection (PIP), and Medical Payments (MP). No two days are the same as you assist our clients with their claims! If you are an agile auto claims examiner with 5+ years of experience, we want to talk to you!

Primary Purpose Of The Role

To analyze and process complex auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability, and evaluating the scope of damages.

Essential Functions And Responsibilities

Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly. Responsible for litigation process on litigated claims. Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims. Reports large claims to excess carrier(s). Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution. Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage. Communicates claim action / processing with insured, client, and agent or broker when appropriate.

Additional Functions And Responsibilities

Performs other duties as assigned. Supports the organization's quality program(s). Travels as required.

Qualifications

Education & Licensing 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.

Experience Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws.

Skills & Knowledge In-depth knowledge of personal and commercial line auto policies, coverage's, principles, and laws. Knowledge of medical terminology for claim evaluation and Medicare compliance. Knowledge of appropriate application for deductibles, sub-limits, SIR's, carrier and large deductible programs. Strong oral and written communication, including presentation skills. PC literate, including Microsoft Office products. Strong organizational skills. Strong interpersonal skills. Good negotiation skills. Ability to work in a team environment. Ability to meet or exceed Service Expectations.

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 the job.

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 $78,951 $87,428 USD annual salary. 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.

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 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.