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Personal Injury Protection Examiner

Sedgwick

1 Positions

ID: R31544

Posted On 01/30/2023

Job Overview

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

Personal Injury Protection Examiner

PRIMARY PURPOSE: To evaluate auto claims involving injured parties and manage first party medical treatment to determine eligibility under a personal injury protection and/or medical payment benefits.

ESSENTIAL FUNCTIONS and 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 coverages.
  • 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.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

  • Performs other duties as assigned.
  • Supports the organization's quality program(s).
  • Travels as required.

QUALIFICATIONS

Education & Licensing
Bachelor's degree from an accredited college or university preferred. State adjuster licenses required.

Experience
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. **Michigan PIP experience required.

Skills & Knowledge

  • 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

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.

at any time.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in CO, NY, WA, or CA. 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 state noted in this job posting only, the range of starting pay for this role is $37,000-60,000. 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.

Primary Contact

1645458383738

Amanda Strothman

,

Phone

Phone

Phone

Fax

amanda.strothman@sedgwick.com

Email

True

False

True

Job Details

Categories

Insurance
Technical

Location

Dubuque, IA

Job Type

Employee

Full/Part

Full Time

Company ID

8326

Job REQ #

R31544

# Positions

1

Start Date

20230130

End Date

20230131

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About the Company

Career Development

Our goal is to make Sedgwick CMS a place where great people can do great things for our clients. This commitment is evidenced by our colleague development program and supported by our multi-dimensional learning resources.

We invest in the education of our colleagues by providing training and learning resources that focus on our culture, procedures, systems and performance expectations. We evaluate the educational needs of our colleagues through performance discussions and evaluations. These needs are filled either through Sedgwick CMS University and through industry certification programs and other external educational resources . Sedgwick CMS University curriculum offerings take colleagues from orientation to technical training to supervisory and managerial development. Through Sedgwick CMS University, we provide our colleagues continuous development of professional skills and the ability to deliver quality service to our clients.

Colleague Orientation

We offer a required colleague orientation program that allows us to verify and document the training provided to new colleagues. This program is called Personal Responsibility in Developing Excellence (PRIDE) and is the first component of our comprehensive career development process. This program introduces and orients new and transitioning colleagues to our company and to their new position. PRIDE will take colleagues through the first 90 days of their new position. Objectives of this program focus on providing colleagues an increased awareness of who we are, where we are going, and how they can help us get there.

Career Paths

Career path options are identified through an ongoing process of discussion and collaboration between colleagues and their managers. On an ongoing basis, our managers counsel colleagues regarding their career path, new opportunities, and additional training and development requirements to help them reach their individual goals.