Claims Examiner – No Fault, PIP, Lit Required

Sedgwick

Claims Examiner resolving personal injury protection claims for Sedgwick, managing and investigating claims across multiple jurisdictions while ensuring compliance and customer service.

Posted 5/3/2026full-timeNew York City • New York • 🇺🇸 United StatesMid-LevelSenior💰 $75,000 - $85,000 per yearWebsite

About the role

Key responsibilities & impact

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.
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.

Requirements

What you’ll need

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.

Benefits

Comp & perks

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.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims investigationclaims negotiationclaims resolutiondata inputclaims managementclaims adjustmentdocumentationcoverage decision makingcustomer servicesuspicious claims identification

Soft Skills

communicationorganizationindependenceproductivityconfidentialitycustomer expectation managementproactive communicationprioritizationproblem-solvingattention to detail

Certifications

State adjusting licenseprofessional certification