Sedgwick · 3 hours ago
Claims Representative, Auto | PIP | Remote
United States
Full-time
Remote
Mid Level
$50K/yr - $55K/yr
3+ years expSedgwick is a leading claims management services company, and they are seeking a Claims Representative to evaluate auto claims involving injured parties. The role involves managing medical treatment eligibility under personal injury protection and medical payment benefits, alongside communicating with clients and negotiating claim resolutions.
BankingInsuranceRisk Management
Responsibilities
Reviews claims to determine the nature of the medical loss and provides explanation of coverage
Researches policy contract and interprets policy language to make coverage decisions based on 1st party medical coverage
Assesses medical treatment, evaluates medical bills, and initiates or reviews potential fraud investigations
Interprets medical records regarding injuries and addresses ongoing and continuous treatment for claimant
Identifies claim exposures and establishes reserves or adjust reserves accordingly on assigned files
Ensures claim files are properly documented and correctly coded based on the policy
Documents all claim activity and workflow accurately throughout the life of the claim in accordance with standard operating procedures
Provides effective and timely communication to client, claimants, medical providers, attorney offices, and vendors
Negotiates resolution of claims and makes payments within authority
Performs other duties as assigned
Supports the organization's quality program(s)
Travels as required
Qualification
Required
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
Knowledge of medical terminology and appropriate application of deductibles and limits
Familiarity with Bodily Injury (BI)/Casualty adjusting
Oral and written communication skills
Detailed oriented
PC literate, including Microsoft Office products
Strong negotiation skills
Good interpersonal and customer skills
Good organization skills
Good time management skills with the ability to multi-task
Ability to work independently and in a team environment
Ability to meet or exceed Performance Competencies
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
Ability to meet deadlines
Computer keyboarding
Travel as required
Hearing, vision and talking
Preferred
Bachelor's degree from an accredited college or university
Nursing experience a plus
Benefits
Medical
Dental
Vision
401k and matching
PTO
Disability and life insurance
Employee assistance
Flexible spending or health savings account
Other additional voluntary benefits
Company
Sedgwick
Sedgwick is the world’s leading risk and claims administration partner, helping clients thrive by navigating the unexpected.
10001+ employees
H1B Sponsorship
Sedgwick has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (11)
2024 (10)
2023 (4)
2022 (9)
2021 (14)
2020 (10)
Funding
Current Stage
Late StageTotal Funding
$1.5BKey Investors
Altas PartnersLa Caisse
2024-09-12Private Equity· $1B
2018-12-01Private Equity
2018-09-12Acquired
Leadership Team
Michael Arbour
Chairman & Chief Executive Officer
Kalani Reelitz
Global Chief Financial Officer
Recent News
Morningstar.com
2025-11-10
2025-09-04
Company data provided by crunchbase