Senior Medical Malpractice Claims Leader

Sedgwick; Oklahoma; On-site; USD 70,000 - 100,000; Full time

Job summary

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

The ideal candidate has extensive claims management experience, strong analytical and negotiation skills, and a track record of timely, cost-effective resolutions. This role focuses on high-exposure cases and coordination of legal defense as needed.

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

Case management

Communication skills

Judgment and discretion

Education

Bachelor's degree preferred

Professional certification applicable to line of business

Job description

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

The ideal candidate has extensive claims management experience, strong analytical and negotiation skills, and a track record of timely, cost-effective resolutions. This role focuses on high-exposure cases and coordination of legal defense as needed.