Remote Senior Medical Malpractice Claims Specialist

Sedgwick; Orlando (FL); Remote; USD 100,000 - 115,000; Full time

Job summary

Sedgwick is seeking a Sr. Claims Specialist for Professional Liability (Medical Malpractice) focused on complex claims management and cost-effective resolutions.

The role emphasizes analytical negotiation, timely investigations, and coordinated defense with counsel. Ideal candidates will handle high-exposure claims, manage reserves, and maintain strong client relationships while following company standards and client-specific guidelines.

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.
• 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 report of investigation for 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.
• Coordinates legal defense by assigning attorneys, coordinating support, and reviewing invoices; ensures compliance with client guidelines.
• Uses cost containment techniques including vendor partnerships to reduce claim costs for clients.
• Identifies and investigates fraud, subrogation, contribution, recovery opportunities to lower total cost.
• Represent 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 coded.
• Refers cases to supervisor and management as appropriate.
• Performs other duties as assigned and supports quality programs.

Skills

Claims management

Analytical skills

Negotiation

Cost containment

Education

Bachelor’s degree

Professional certification (as applicable)

Job description

Sedgwick is seeking a Sr. Claims Specialist for Professional Liability (Medical Malpractice) focused on complex claims management and cost-effective resolutions.

The role emphasizes analytical negotiation, timely investigations, and coordinated defense with counsel. Ideal candidates will handle high-exposure claims, manage reserves, and maintain strong client relationships while following company standards and client-specific guidelines.