Senior Claims Specialist - Medical Malpractice

June 21

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Sedgwick

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Sedgwick is a global provider of technology-enabled risk, benefits, and integrated business solutions. They help people and organizations by managing and mitigating risk with solutions in accident, health, disability, unemployment compensation, and liability claims administration, among others. Sedgwick offers services such as claims administration, building consulting, forensic accounting, and forensic engineering. Their specialties include property restoration, brand protection, and loss prevention across several industries, including agriculture, construction, and environmental sectors. The company emphasizes diversity, equity, and inclusion (DEI) as well as environmental, social, and governance (ESG) practices.

claims management • risk management • workers'​ compensation • disability • absence solutions

10,000+ employees

🏢 Enterprise

📋 Compliance

📋 Description

• To analyze complex or technically difficult medical malpractice claims. • To provide resolution of highly complex nature and/or severe injury claims. • To coordinate case management within Company standards, industry best practices and specific client service requirements. • To manage total claim costs while providing high levels of customer service. • Analyze and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim. • Manages claims through well-developed action plans to an appropriate and timely resolution. • Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions. • Negotiates claim settlement up to designated authority level. • Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout the claim life. • Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement. • Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients. • Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost. • Represents Company in depositions, mediations, and trial monitoring as needed. • Communicates claim activity and processing with the client; maintains professional client relationships. • Ensures claim files are properly documented and claims coding is correct. • Refers cases as appropriate to supervisor and management. • Delegates work and mentors assigned staff.

🎯 Requirements

• Six (6) years of claims management experience or equivalent combination of education and experience required. • In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business. • Excellent oral and written communication, including presentation skills. • PC literate, including Microsoft Office products. • Analytical and interpretive skills. • Strong organizational skills. • Excellent negotiation skills. • Good interpersonal skills. • Ability to work in a team environment. • Ability to meet or exceed Performance Competencies.

🏖️ Benefits

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