Senior Claims Specialist, Medical Malpractice – Professional Liability

🔥 4 minutes ago

🇺🇸 United States – Remote

💵 $110k - $120k / year

⏰ Full Time

🟠 Senior

📋 Claims Specialist

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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

• Analyze and process complex or technically difficult medical malpractice claims • Investigate claims and gather information to determine claim exposure • Manage claims through action plans to timely and appropriate resolution • Conduct or assign full investigations and report on new events, claims, and legal actions • Calculate and assign timely, appropriate claim reserves and monitor reserve adequacy • Recommend settlement strategies and bring structured settlement proposals when necessary • Coordinate legal defense, assign attorneys, support investigations, review attorney invoices, and monitor counsel compliance with client guidelines • Apply cost-containment techniques and strategic vendor partnerships to reduce client 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 claim coding is correct • Refer cases to supervisors and management as appropriate • Support the organization's quality programs • Perform other assigned duties

🎯 Requirements

• 6 years of claims management experience, or equivalent combination of education and experience • Bachelor's degree from an accredited college or university preferred • Licenses as required • Professional certification applicable to the line of business preferred • Computer keyboarding ability • Hearing, vision, and talking ability • Clear and conceptual thinking ability • Excellent judgment and discretion • Ability to meet deadlines • Strong analytical and negotiation skills • Sound judgment • Commitment to timely, cost-effective claim resolutions and high customer service

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • 401(k) and matching • Paid time off (PTO) • Disability insurance • Life insurance • Employee assistance program • Flexible spending account or health savings account • Other additional voluntary benefits • Work-life balance • Caring culture