Remote Senior Medical Malpractice Claims Specialist

Sedgwick; Dallas (TX); Teletrabalho; USD 100 000 - 115 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Health insurance

401k matching

PTO

Life insurance

Resumo da oferta

Sedgwick is seeking a Sr. Claims Specialist, Professional Liability (Medical Malpractice) to analyze complex claims and coordinate case management.

You will manage exposure, reserves, and settlements with a strong focus on client service and cost containment. Ideal candidates bring analytical and negotiating strengths, sound judgment, and a commitment to timely, cost-efficient resolutions while upholding high standards of customer service.

Qualificações

• 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.

Responsabilidades

• 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).

Conhecimentos

Analytical skills

Negotiation skills

Judgement and discretion

Deadline-oriented

Formação académica

Bachelor's degree preferred

Professional certification as applicable to line of business

Descrição da oferta de emprego

Sedgwick is seeking a Sr. Claims Specialist, Professional Liability (Medical Malpractice) to analyze complex claims and coordinate case management.

You will manage exposure, reserves, and settlements with a strong focus on client service and cost containment. Ideal candidates bring analytical and negotiating strengths, sound judgment, and a commitment to timely, cost-efficient resolutions while upholding high standards of customer service.