Senior Medical Malpractice Claims Lead | Complex Exposures

Sedgwick; Long Beach (CA); On-site; USD 100,000 - 125,000; Full time

Job summary

Sedgwick in California seeks a Sr. Claims Specialist to analyze complex medical malpractice claims, manage high-exposure matters, and coordinate timely, cost-conscious resolutions with clients and defense counsel.

The ideal candidate brings extensive malpractice experience, sharp analytical and negotiation skills, and a track record of accurate reserving and collaborative case management to achieve favorable outcomes.

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

Claims management experience

Education

Bachelor's degree

Professional certification

Job description

Sedgwick in California seeks a Sr. Claims Specialist to analyze complex medical malpractice claims, manage high-exposure matters, and coordinate timely, cost-conscious resolutions with clients and defense counsel.

The ideal candidate brings extensive malpractice experience, sharp analytical and negotiation skills, and a track record of accurate reserving and collaborative case management to achieve favorable outcomes.