Claims Advisor, Medical Malpractice (Professional Liability)

National African-American Insurance Association (NAAIA); Texas; On-site; USD 70,000 - 90,000; Full time

Job summary

A leading insurance company seeks a Claims Advisor specializing in Medical Malpractice. This role involves analyzing complex claims, negotiating settlements, and managing legal defenses while ensuring high customer service levels. Candidates should have a Bachelor's degree and significant claims management experience, along with strong analytical and negotiation skills.

Qualifications

• Bachelor's degree preferred; licenses as required.
• Six years of claims management experience required.
• Professional certification preferred.

Responsibilities

• Analyze and process complex medical malpractice claims.
• Negotiate claim settlements and manage claims through action plans.
• Coordinate legal defense and monitor compliance with client guidelines.

Skills

Negotiation

Analytical skills

Interpersonal skills

Organizational skills

Communication skills

Education

Bachelor's degree from an accredited college or university

Tools

Microsoft Office

Job description

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies

Certified as a Great Place to Work

Fortune Best Workplaces in Financial Services & Insurance

Claims Advisor, Medical Malpractice (Professional Liability)

PRIMARY PURPOSE: To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.
• Negotiates claim settlement up to designated authority level.
• Calculates and assigns timely and appropriate reserves to claims, monitors reserve adequacy throughout claim life.
• Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement.
• Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices, monitors counsel for compliance with client guidelines.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients.
• Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
• Represents Company in depositions, mediations, and trial monitoring as needed.
• Communicates claim activity and processing with the client; maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate to supervisor and management.
• Delegates work and mentors assigned staff.

ADDITIONAL FUNCTIONS and RESPONSIBITLIITES

• Performs other duties as assigned.
• Supports the organizations quality program(s).

QUALIFICATION

Education & Licensing

Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred.

Experience

Six (6) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge

• In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business
• Ability to work in a team environment
• Good interpersonal skills
• Excellent negotiation skills
• Strong organizational skills
• Analytical and interpretive skills
• PC literate, including Microsoft Office products
• Excellent oral and written communication, including presentation skills

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

NOTE: Credit security clearance, confirmed via a background credit check, is required for this position.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.