Remote Senior Medical Malpractice Claims Specialist

Sedgwick; Flagstaff (AZ); Remote; USD 100,000 - 115,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401k with match

PTO

Disability insurance

Life insurance

Employee assistance program

FSA/HSA

Job summary

Sedgwick in the United States is seeking a Sr. Claims Specialist, Medical Malpractice to analyze complex claims and coordinate resolution with clients.

The role emphasizes strong analytical skills, negotiation, and cost-conscious management of high-exposure cases. The ideal candidate will have 6+ years of claims management experience, a bachelor’s degree (or equivalent), and professional certification where applicable.

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 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).

Skills

Analytical skills

Negotiation skills

Judgment

Customer service

Education

Bachelor's degree preferred

Professional certification preferred

Job description

Sedgwick in the United States is seeking a Sr. Claims Specialist, Medical Malpractice to analyze complex claims and coordinate resolution with clients.

The role emphasizes strong analytical skills, negotiation, and cost-conscious management of high-exposure cases. The ideal candidate will have 6+ years of claims management experience, a bachelor’s degree (or equivalent), and professional certification where applicable.