Claims Representative, Auto, PIP

Sedgwick

. Evaluate auto claims involving injured parties and manage first party medical treatment to determine eligibility under personal injury protection and/or medical payment benefits .

Posted 11/11/2026full-timeRemote • United StatesMid-LevelSenior💰 $55,000 - $60,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in evaluating auto claims, managing medical treatment eligibility, and interpreting policy language. Proficient in negotiation, documentation, and maintaining compliance with personal injury protection standards.

Highest-signal resume keywords

State Adjuster LicensesPersonal Injury Protection (PIP)Medical Terminology KnowledgeStrong Negotiation SkillsBodily Injury (BI)/Casualty Adjusting

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims EvaluationMedical Bill AssessmentFraud InvestigationPolicy InterpretationClaim DocumentationReserve AdjustmentMedical Record InterpretationPerformance CompetenciesKeyboarding SkillsDeadline Management

Soft Skills

Independent WorkTeam CollaborationCommunication SkillsMulti-Priority Management

Tools & Technologies

Microsoft Office

Certifications & Qualifications

Bachelor's Degree (Preferred)Nursing Experience (Plus)

Industry Keywords

Personal Injury ProtectionMedical Payment BenefitsWorkers CompensationClaim ExposuresQuality Programs

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 medical loss and explain coverage
Research policy contracts and interpret policy language to make coverage decisions
Assess medical treatment, evaluate medical bills, and initiate or review potential fraud investigations
Interpret medical records regarding injuries and address ongoing and continuous treatment
Identify claim exposures and establish or adjust reserves
Ensure claim files are properly documented and correctly coded
Document claim activity and workflow throughout the life of the claim
Communicate with clients, claimants, medical providers, attorney offices, and vendors
Negotiate claim resolutions and make payments within authority
Support the organization's quality programs
Perform other assigned duties

Requirements

What you’ll need

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
Bachelor's degree from an accredited college or university preferred
Nursing experience a plus
Knowledge of medical terminology and appropriate application of deductibles and limits
Familiarity with Bodily Injury (BI)/Casualty adjusting
PC literate, including Microsoft Office products
Strong negotiation skills
Ability to meet or exceed Performance Competencies
Ability to work independently and in a team environment
Ability to meet deadlines and manage multiple priorities
Computer keyboarding; travel as required

Benefits

Comp & perks

Medical insurance
Dental insurance
Vision insurance
401k and matching
PTO
Disability insurance
Life insurance
Employee assistance
Flexible spending or health savings account
Other additional voluntary benefits
Reasonable accommodations when applicable and appropriate