Remote Senior Medical Malpractice Claims Specialist

Sedgwick; Boise (ID); Remote; USD 100,000 - 115,000; Full time

Benefits offered by this job

Medical, dental, vision

401k and matching

PTO

Life insurance

Job summary

Sedgwick is seeking a Sr. Claims Specialist to analyze complex medical malpractice claims with high exposure, including New Jersey claims, and to coordinate within company standards and client requirements.

You will manage total claim costs while delivering high levels of customer service. Ideal candidates bring strong analytical and negotiation skills, sound judgment, and experience guiding investigations, reserves, and settlements.

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.

Responsibilities

• Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine exposure; manages claims to timely resolution.
• Conducts or assigns full investigation and provides reports of investigation pertaining to new events, claims and legal actions.
• Calculates and assigns timely reserves; monitors reserve adequacy throughout claim life.
• Recommends settlement strategies; presents structured settlement proposals to maximize settlement when needed.
• Coordinates legal defense by assigning attorney and reviewing invoices; ensures compliance with client guidelines.
• Uses cost containment techniques including vendor partnerships to reduce total claim cost for clients.
• Identifies opportunities for subrogation, recovery, and case management to reduce total cost.
• Represents Company in depositions, mediations, and trial monitoring as needed.
• Communicates claim activity with the client and maintains professional relationships.
• Ensures claim files are properly documented and coding is correct.
• Refer cases to supervisor as appropriate; performs other duties as assigned.

Skills

Analytical skills

Negotiation skills

Sound judgment

Education

Bachelor's degree

Licenses as required

Professional certification

Job description

Sedgwick is seeking a Sr. Claims Specialist to analyze complex medical malpractice claims with high exposure, including New Jersey claims, and to coordinate within company standards and client requirements.

You will manage total claim costs while delivering high levels of customer service. Ideal candidates bring strong analytical and negotiation skills, sound judgment, and experience guiding investigations, reserves, and settlements.