Senior Claims Specialist, Professional Liability, Medical Malpractice

🔥 2 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $100k - $125k / 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 resolution • Conduct or assign full investigations and provide investigation reports • Calculate and assign reserves and monitor reserve adequacy • Recommend settlement strategies and bring structured settlement proposals • Coordinate legal defense, assign attorneys, support investigations, and review attorney invoices • Monitor counsel for compliance with client guidelines • Use cost containment techniques and strategic vendor partnerships • Identify and investigate 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 properly documented and claims coding is correct • Refer cases to supervisors and management as appropriate • Support the organization's quality programs • Perform other duties as assigned

🎯 Requirements

• 6 years of claims management experience or equivalent combination of education and experience required • Bachelor's degree from an accredited college or university preferred • Licenses as required • Professional certification as applicable to line of business preferred • Experience managing complex medical malpractice claims involving severe injury and high exposure • Strong analytical and negotiation skills • Sound judgment • Ability to deliver timely, cost-effective claim resolutions • Ability to maintain a high level of customer service • Computer keyboarding • Hearing, vision and talking • Clear and conceptual thinking ability • Excellent judgement and discretion • Ability to meet deadlines

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • 401(k) and matching • PTO • Disability insurance • Life insurance • Employee assistance • Flexible spending or health savings account • Other additional voluntary benefits • Work-life balance • Equal opportunity workplace • Drug-free workplace

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