Remote Senior Medical Malpractice Claims Specialist

Sedgwick; Austin (TX); À distance; USD 100 000 - 115 000; Plein temps

Avantages offerts par ce poste

Medical benefits

Dental benefits

Vision benefits

401k & matching

PTO

Disability insurance

Life insurance

Employee assistance program

HSA/FSA

Résumé du poste

Sedgwick is actively seeking a Sr. Claims Specialist to analyze complex medical malpractice claims and manage high exposure cases with strong analytical and negotiation skills. This role emphasizes timely resolutions and outstanding client service in a remote-capable setting.

You will coordinate investigations, set reserves, develop settlement strategies, and oversee defense counsel while maintaining quality client relationships. A Bachelor's degree and 6 years of claims experience are expected.

Qualifications

• 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.

Responsabilités

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

Connaissances

Analytical skills

Negotiation skills

Customer service

Formation

Bachelor's degree

Professional certification

Description du poste

Sedgwick is actively seeking a Sr. Claims Specialist to analyze complex medical malpractice claims and manage high exposure cases with strong analytical and negotiation skills. This role emphasizes timely resolutions and outstanding client service in a remote-capable setting.

You will coordinate investigations, set reserves, develop settlement strategies, and oversee defense counsel while maintaining quality client relationships. A Bachelor's degree and 6 years of claims experience are expected.