Professional Liability Claims Advisor (Remote)

Sedgwick; California; On-site; USD 70,000 - 95,000; Full time

Job summary

Sedgwick, a global leader recognized for excellence in claims management, seeks a Remote Professional Liability Claims Advisor. You will handle MedMal and professional liability claims, investigate complex exposures, and drive timely resolutions with a client-first approach.

This remote role requires availability during Pacific Time Zone business hours and offers flexible work arrangements, development opportunities, and comprehensive benefits.

Qualifications

• Education & Licensing: High School Diploma or GED required. Bachelor’s degree from an accredited college or university preferred.
• Experience: 3-5 years of medical malpractice and professional liability claims management experience required.

Responsibilities

• Analyzes and processes complex MedMal and Professional Liability claims by investigating and gathering information to determine exposure and manages claims to resolution.
• Conducts or assigns full investigation and provides investigation reports for new events, claims and legal actions.
• Negotiates claim settlements up to designated authority level.
• Calculates and assigns reserves; monitors reserve adequacy throughout the claim life.
• Recommends settlement strategies and presents structured settlements to maximize outcomes.
• Performs coverage analysis and opinions as part of the claim process including all necessary correspondence.
• Coordinates legal defense by assigning attorneys, coordinating support, and reviewing invoices; monitors counsel for compliance with client guidelines.
• Uses cost containment techniques and strategically partners with vendors to reduce total claim cost for clients.

Skills

Medical Malpractice

Professional Liability

Claims Investigation

Coverage Evaluation

Settlement Negotiation

Education

High School Diploma or GED

Bachelor's degree preferred

Professional certification (as applicable)

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
Professional Liability Claims Advisor (Remote)
Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?

• Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
• Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.
• Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
• Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights.
• Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
• Enjoy flexibility and autonomy in your daily work, your location, and your career path.
• Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
  

ARE YOU AN IDEAL CANDIDATE? You bring experience handling complex Medical Malpractice and/or Professional Liability claims, excel at investigating claims, evaluating coverage, and driving strategic resolutions, and thrive in a client-focused environment where you can manage high-exposure files, collaborate with defense counsel, and mentor others while delivering exceptional results.
WORK LOCATIONSThis role requires availability during Pacific Time Zone business hours. See posting for eligible locations.
PRIMARY PURPOSE OF THE ROLE: Manage and handle MedMal and professional liability claims; to provide resolution of highly complex nature and/or severe 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 Responsiblities May Include

• Analyzes and processes complex or technically difficult MedMal and Professional Liability 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.
• Performs coverage analysis and opinion as part of the claim process including all necessary correspondence.
• 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 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 others.

Qualifications

• Education & Licensing: High School Diploma or GED required. Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
• Experience: 3-5 years of medical malpractice and professional liability claims management experience required.
  

TAKING CARE OF YOU

• Flexible work schedule.
• Referral incentive program.
• Opportunity to work in an agile environment.
• Career development and promotional growth opportunities.
• A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Work Environment Requirements Include
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