Senior Medical Malpractice Claims Specialist

Sedgwick; Eagle (ID); On-site; USD 100,000 - 115,000; Full time

Benefits offered by this job

Comprehensive benefits package

401k and matching

Paid time off (PTO)

Disability and life insurance

Employee assistance

Job summary

Sedgwick is hiring a Sr. Claims Specialist for Medical Malpractice in New Jersey. The role analyzes complex malpractice claims, coordinates investigations, and manages cost-effective resolutions while delivering strong client service.

Ideal candidates have 6+ years in claims management, a bachelor's degree, and applicable professional certifications. A comprehensive benefits package accompanies the role.

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 exposure; manages claims to resolution.
• Conducts or assigns full investigation and provides reports for new events, claims and legal actions.
• Calculates and assigns reserves; monitors reserve adequacy throughout claim life.
• Recommends settlement strategies and presents structured proposals to maximize settlement.
• Coordinates legal defense by assigning attorney and reviewing invoices; ensures compliance with client guidelines.
• Uses cost containment techniques including vendor partnerships to reduce claim costs.
• Identifies fraud, subrogation, contribution, recovery opportunities to reduce costs.
• Represents Company in depositions, mediations, and trial monitoring as needed.
• Keeps clients informed of claim activity and maintains professional relationships.
• Ensures proper documentation and coding of claim files.

Skills

Analytical skills

Negotiation skills

Claims management experience

Education

Bachelor's degree

Professional certification appropriate to line of business

Job description

Sedgwick is hiring a Sr. Claims Specialist for Medical Malpractice in New Jersey. The role analyzes complex malpractice claims, coordinates investigations, and manages cost-effective resolutions while delivering strong client service.

Ideal candidates have 6+ years in claims management, a bachelor's degree, and applicable professional certifications. A comprehensive benefits package accompanies the role.