Remote Senior Medical Malpractice Claims Specialist

Sedgwick; Houston (TX); Remote; USD 100,000 - 115,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401k and matching

PTO

Job summary

Sedgwick is seeking a Sr. Claims Specialist in Medical Malpractice to analyze and resolve complex claims with high exposure. You will coordinate case management, manage reserves, and steer settlements while upholding superior client service.

You will lead investigations, coordinate defense teams, and ensure accurate documentation and coding of all files. A strong negotiation mindset and cost-containment focus are essential.

Qualifications

• 6 years of claims management experience or equivalent combination of education and experience.
• 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.
• 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.

Skills

Claims management

Analytical skills

Negotiation

Cost containment

Legal coordination

Education

Bachelor's degree

Professional certification

Job description

Sedgwick is seeking a Sr. Claims Specialist in Medical Malpractice to analyze and resolve complex claims with high exposure. You will coordinate case management, manage reserves, and steer settlements while upholding superior client service.

You will lead investigations, coordinate defense teams, and ensure accurate documentation and coding of all files. A strong negotiation mindset and cost-containment focus are essential.