Senior Claims Specialist, Medical Malpractice

🔥 8 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 and gather information to determine claim exposure • Manage claims through action plans to timely and appropriate resolution • Conduct or assign investigations and provide investigation reports • Negotiate claim settlements up to designated authority level • Calculate, assign, and monitor claim reserves • Recommend settlement strategies and develop structured settlement proposals • Coordinate legal defense, assign attorneys, support investigations, and review attorney invoices • Monitor counsel compliance with client guidelines • Apply cost containment techniques and strategic vendor partnerships • 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 • Maintain professional client relationships • Ensure claim files are documented and claims coding is correct • Refer cases to supervisors and management as appropriate • Delegate work and mentor assigned staff • Support the organization's quality programs • Perform other duties as assigned

🎯 Requirements

• Bachelor's degree from an accredited college or university preferred • Licenses as required • Professional certification as applicable to line of business preferred • 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 • 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 • 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 • Credit security clearance confirmed via a background credit check is required

🏖️ 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 • Reasonable accommodations when applicable and appropriate

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