Senior Medical Malpractice Claims Specialist

Sedgwick; Providence (RI); On-site; USD 100,000 - 115,000; Full time

Benefits offered by this job

Medical

Dental

Vision

401k and matching

PTO

Disability and life insurance

Employee assistance

FSA/HSA

Voluntary benefits

Job summary

Sedgwick is seeking a Sr. Claims Specialist to analyze and resolve complex medical malpractice claims with a focus on severe exposure and cost-effective outcomes.

You will coordinate investigations, manage reserves, and collaborate with legal teams and clients to deliver timely resolutions. The role requires strong analytical and negotiation skills, adherence to client guidelines, and commitment to high-quality service.

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 through well-developed action plans to resolution.
• Conducts or assigns full investigation and provides reports of investigation pertaining to new events, claims and legal actions.
• Calculates and assigns timely reserves; 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 invoices; monitors counsel for client guidelines compliance.
• Uses cost containment techniques including strategic vendor partnerships to reduce overall claim costs.
• Identifies and investigates fraud, subrogation, contribution, recovery 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 to supervisor and management when appropriate.
• Performs other duties as assigned and supports the organization's quality programs.

Education

Bachelor's degree from an accredited college or university preferred

Job description

Sedgwick is seeking a Sr. Claims Specialist to analyze and resolve complex medical malpractice claims with a focus on severe exposure and cost-effective outcomes.

You will coordinate investigations, manage reserves, and collaborate with legal teams and clients to deliver timely resolutions. The role requires strong analytical and negotiation skills, adherence to client guidelines, and commitment to high-quality service.