Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work.
Great Place to Work®
Most Loved Workplace®
Forbes Best-in-State Employer
No-Fault/PIP/NJ SAIP Injury Examiner
PRIMARY PURPOSE: 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.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
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.
Supports team members to resolve issues and identify appropriate matters for escalation.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Travel as required
QUALIFICATIONS
Education & Licensing
Bachelor's degree from an accredited college or university preferred. Licenses as required.
Experience
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.
Skills & Knowledge
Deep knowledge and understanding of the auto claims contract as well as application of case law, state laws and regulations
Ability to interface with internal and external customers in a pleasant manner on an ongoing basis
Ability to maintain discretion in business relationships and exercise sound business judgement
Excellent oral and written communication skills, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Excellent interpersonal skills
Excellent negotiating skills
Ability to create and complete comprehensive, accurate and constructive written reports
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
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
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.
Pay Transparency:
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 60,250.00 . 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.
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.
Taking care of people is at the heart of everything we do. Caring counts
Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing.
Headway Design and Development
United States - NH - NH - Rye
June 28, 2024
Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients to providing and overseeing medication management. • Whether you're new to private practice or already have an established practice of your own, we re excited to support you in...
United States - NH - NH - Peterborough
June 28, 2024
About TinkBird is a comprehensive healthcare recruiting and job placement firm for locum tenens, travel nursing and allied positions as well as permanent medical placements. • Serving nationwide, we focus on providing quality matches, superior customer service with full transparency, and a...
United States - NH - NH - Manchester
June 28, 2024
CrossMed Allied is seeking a travel Ultrasound Technologist for a travel job in Manchester, New Hampshire. & Requirements • Specialty: Ultrasound Technologist • Discipline: Allied Health Professional • Start Date: ASAP • Duration: 13 weeks • 40 hours per week • Shift: 8 hours • Employment Type:...
Interim HealthCare of New Hampshire
United States - NH - NH - Hill
June 28, 2024
Registered Nurse Case Manager Laconia, NH $38-$43/HR Interim HealthCare is currently seeking a full-time Registered Nurse Case Manager based out of our Laconia NH office. • The Registered Nurse Case Manager position is responsible for managing a defined caseload of patients providing direct patient...
Headway Design and Development
United States - NH - NH - Lancaster
June 28, 2024
Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients to providing and overseeing medication management. • Whether you're new to private practice or already have an established practice of your own, we re excited to support you in...
United States - NH - NH - New London
June 28, 2024
CrossMed Allied is seeking a travel Radiology Technician for a travel job in New London, New Hampshire. & Requirements • Specialty: Radiology Technician • Discipline: Allied Health Professional • Start Date: 07/22/2024 • Duration: 13 weeks • 36 hours per week • Shift: 12 hours • Employment Type:...
Headway Design and Development
United States - NH - NH - Milford
June 28, 2024
Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients to providing and overseeing medication management. • Whether you're new to private practice or already have an established practice of your own, we re excited to support you in...
Headway Design and Development
United States - NH - NH - Epping
June 28, 2024
Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients to providing and overseeing medication management. • Whether you're new to private practice or already have an established practice of your own, we re excited to support you in...
Headway Design and Development
United States - NH - NH - Derry
June 28, 2024
Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients to providing and overseeing medication management. • Whether you're new to private practice or already have an established practice of your own, we re excited to support you in...
Headway Design and Development
United States - NH - NH - Gilford
June 28, 2024
Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients to providing and overseeing medication management. • Whether you're new to private practice or already have an established practice of your own, we re excited to support you in...
Headway Design and Development
United States - NH - NH - Londonderry
June 28, 2024
Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients to providing and overseeing medication management. • Whether you're new to private practice or already have an established practice of your own, we re excited to support you in...
United States - NH - NH - Dover
June 28, 2024
Advantis Medical is seeking a travel nurse RN OR - Operating Room for a travel nursing job in Dover, New Hampshire. & Requirements • Specialty: OR - Operating Room • Discipline: RN • Duration: 13 weeks • 36 hours per week • Shift: 12 hours, days • Employment Type: Travel Advantis Medical, the #1...
Headway Design and Development
United States - NH - NH - Hampstead
June 28, 2024
Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients to providing and overseeing medication management. • Whether you're new to private practice or already have an established practice of your own, we re excited to support you in...
United States - NH - NH - Lebanon
June 28, 2024
OverviewMedical Social Worker • Full Time, Days • Why work as a Medical Social Worker at the Visiting Nurse and Hospice for Vermont and New Hampshire? • You really get to know your patients and become an integral part of their care team. • Your average visit is 45 minutes giving you significant time...
Headway Design and Development
United States - NH - NH - Lancaster
June 28, 2024
Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients to providing and overseeing medication management. • Whether you're new to private practice or already have an established practice of your own, we re excited to support you in...
United States - NH - NH - Lebanon
June 28, 2024
CrossMed Allied is seeking a travel Radiology Technician for a travel job in Lebanon, New Hampshire. & Requirements • Specialty: Radiology Technician • Discipline: Allied Health Professional • Start Date: ASAP • Duration: 13 weeks • 40 hours per week • Shift: 8 hours • Employment Type: Travel Why...
United States - NH - NH - Dover
June 28, 2024
CrossMed Allied is seeking a travel Radiology Technician for a travel job in Dover, New Hampshire. & Requirements • Specialty: Radiology Technician • Discipline: Allied Health Professional • Start Date: 07/15/2024 • Duration: 13 weeks • 40 hours per week • Shift: 8 hours • Employment Type: Travel...
Headway Design and Development
United States - NH - NH - Tilton
June 28, 2024
Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients to providing and overseeing medication management. • Whether you're new to private practice or already have an established practice of your own, we re excited to support you in...
Headway Design and Development
United States - NH - NH - Swanzey
June 28, 2024
Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients to providing and overseeing medication management. • Whether you're new to private practice or already have an established practice of your own, we re excited to support you in...
Headway Design and Development
United States - NH - NH - Lebanon
June 28, 2024
Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients to providing and overseeing medication management. • Whether you're new to private practice or already have an established practice of your own, we re excited to support you in...
Headway Design and Development
United States - NH - NH - Hampton
June 28, 2024
Mental health clinicians use Headway in a number of ways, ranging from conducting psychotherapy sessions with patients to providing and overseeing medication management. • Whether you're new to private practice or already have an established practice of your own, we re excited to support you in...
United States - NH - NH - Concord
June 28, 2024
Triage Staffing is seeking a travel Medical Lab Technician for a travel job in Concord, New Hampshire. & Requirements • Specialty: Medical Lab Technician • Discipline: Allied Health Professional • Start Date: ASAP • Duration: 13 weeks • 40 hours per week • Shift: 8 hours, evenings • Employment Type:...
United States - NH - NH - Hinsdale
June 28, 2024
STYLIST IN TRAINING WHAT WE OFFER • Would you like to be one of our future stylists? If you've got the desire, we've got the knowhow to get you there. As a stylist-in-training in this temporary 90-day position we're here to help you learn the business while you deliver exceptional customer service...
United States - NH - NH - Peterborough
June 28, 2024
Summary : • Physical therapists help patients with injuries and chronic health conditions regain their range of motion, manage their pain, and improve their quality of life. • PTs play a critical role not only in treating musculoskeletal conditions but also in educating patients about staying fit...
United States - NH - NH - Nashua
June 28, 2024
CrossMed Allied is seeking a travel Radiology Technician for a travel job in Nashua, New Hampshire. & Requirements • Specialty: Radiology Technician • Discipline: Allied Health Professional • Start Date: 07/08/2024 • Duration: 13 weeks • 40 hours per week • Shift: 8 hours • Employment Type: Travel...
United States - NH - NH - Lebanon
June 28, 2024
We. • Are. • OneStaff. • Medical. • An independently-owned, nationally-recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by your side and help you find your dream assignment anywhere in this great country. • We want the...
United States - NH - NH - Farmington
June 28, 2024
Why CAST AI? CAST AI is the leading Kubernetes cost optimization platform for AWS, GCP and Azure customers. The company is on a mission to deliver a fully automated Kubernetes experience. Whats unique about CAST AI is that its platform goes beyond monitoring clusters and making recommendations; it...