Claims Advisor, Professional Liability – Medical Malpractice

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🗽 New York – Remote

🗽 New York – Remote

💵 $100k - $125k / year

⏰ Full Time

🟠 Senior

🔴 Lead

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Sedgwick

WebsiteLinkedInAll Job Openings

10,000+ employees

🏗️ Construction

💼 Consulting

🏥 Healthcare

Construction • Consulting • Healthcare

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.

📋 Description

• Manage and handle medical malpractice and professional liability claims • Resolve highly complex and/or severe injury claims • Coordinate case management within company standards, industry best practices, and client service requirements • Manage total claim costs while providing high levels of customer service • Analyze and process complex or technically difficult liability claims by investigating and gathering information to determine exposure • Manage claims through action plans to timely resolution • Conduct or assign full investigations and provide investigation reports for new events, claims, and legal actions • Negotiate claim settlements up to designated authority level • Calculate, assign, and monitor appropriate claim reserves • Recommend settlement strategies and bring structured settlement proposals as needed • Perform coverage analysis and opinions, including required correspondence • Coordinate legal defense, assign attorneys, support investigations, and review attorney invoices • Monitor counsel compliance with client guidelines • Use cost containment techniques and strategic vendor partnerships to reduce claim costs • Investigate potential fraud, subrogation, contribution, recovery, and case management opportunities • Represent the company in depositions, mediations, and trial monitoring as needed • Communicate claim activity and processing with clients and maintain professional client relationships • Ensure claim files are properly documented and coding is correct • Refer cases to supervisors and management as appropriate • Delegate work and mentor others

🎯 Requirements

• Ten (10) years of complex claims management experience required, or equivalent combination of education and experience • Master’s or Juris Doctorate degree from an accredited college or university preferred • Licenses as required • Preferred designations/licensing may include Bachelor of Science in Nursing, Legal Nurse Consultant, Associate in Claims (AIC), Chartered Property and Casualty Underwriter (CPCU), Associate in Risk Management (ARM), and Certified Professional in Health Care Risk Management (CPHRM) • In-depth knowledge of medical malpractice insurance principles and laws • Knowledge of recoveries, offsets and deductions, claim and disability duration, and cost containment principles • Knowledge of medical management practices and Social Security application procedures as applicable • Extensive knowledge and comprehension of insurance coverage • Claims expertise in medical malpractice, errors and omissions, directors and officers, life sciences, and/or cyber liability • Excellent oral and written communication, including presentation skills • PC literacy, 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 • Ability to perform computer keyboarding • Hearing, vision, and talking abilities • Clear and conceptual thinking ability, excellent judgment and discretion, and ability to meet deadlines

🏖️ Benefits

• 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 • Work-life balance • Caring culture