Senior Claims Specialist, Professional Liability, Medical Malpractice, Long Term Care

🔥 18 hours ago

🗽 New York – Remote

🗽 New York – Remote

💵 $100k / year

⏰ Full Time

🟠 Senior

📋 Claims Specialist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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 complex or technically difficult medical malpractice claims, including long term care facility claims • Provide resolution of 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 • Investigate and gather information to determine claim exposure • Manage claims through action plans to appropriate and timely resolution • Conduct or assign full investigations and report on new events, claims, and legal actions • Calculate and assign timely and appropriate claim reserves; monitor reserve adequacy • Recommend settlement strategies and bring structured settlement proposals as necessary • Coordinate legal defense, assign attorneys, support investigations, review attorney invoices, and monitor counsel compliance • Use cost containment techniques and strategic vendor partnerships to reduce claim costs • 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 and 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 • High level of customer service • Clear and conceptual thinking ability • Excellent judgement and discretion • Ability to meet deadlines • Computer keyboarding • Hearing, vision and talking

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • 401(k) and matching • PTO • Disability insurance • Life insurance • Employee assistance • Flexible spending account or health savings account • Other additional voluntary benefits • Work-life balance • Caring culture • Professional growth and career development opportunities