Claims Representative, Auto, PIP

Sedgwick

Claims Representative evaluating and managing first party medical treatment eligibility for auto claims at Sedgwick. Collaborating with clients and medical providers for efficient claims resolution.

Posted 5/3/2026full-timeRemote • Florida, New Jersey, New York, Ohio • 🇺🇸 United StatesMid-LevelSenior💰 $50,000 - $55,000 per yearWebsite

About the role

Key responsibilities & impact

Evaluate auto claims involving injured parties and manage first party medical treatment to determine eligibility under personal injury protection and/or medical payment benefits
Review claims to determine the nature of the medical loss and provide explanation of coverage
Research policy contract and interpret policy language to make coverage decisions based on 1st party medical coverage
Assess medical treatment, evaluate medical bills, and initiate or review potential fraud investigations
Interpret medical records regarding injuries and address ongoing treatment for claimants
Identify claim exposures and establish reserves accordingly on assigned files
Ensure claim files are properly documented and correctly coded based on the policy
Document all claim activity accurately throughout the claim life
Provide effective communication to clients, claimants, medical providers, and vendors
Negotiate resolution of claims and make payments within authority

Requirements

What you’ll need

Bachelor's degree from an accredited college or university preferred
State adjuster licenses required
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
knowledge of medical terminology and appropriate application of deductibles and limits
familiarity with Bodily Injury (BI)/Casualty adjusting
organizational skills required

Benefits

Comp & perks

medical
dental
vision
401k and matching
PTO
disability and life insurance
employee assistance
flexible spending or health savings account
additional voluntary benefits

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims evaluationmedical treatment assessmentpolicy interpretationfraud investigationmedical billing evaluationcoverage decision makingdocumentation codingnegotiationcommunication

Soft Skills

organizational skillseffective communication

Certifications

state adjuster licenses