Senior Medical Malpractice Claims Specialist

Sedgwick Claims Management Services Ltd; United States; A distancia; USD 100.000 - 125.000; Jornada completa

Descripción de la vacante

Sedgwick is seeking a Sr. Claims professional to analyze complex medical malpractice claims and coordinate case management. You will resolve high-cost, high-exposure matters with strong analytical and negotiation skills, while delivering excellent customer service.

The role emphasizes managing reserves, coordinating legal defense, and applying cost-containment strategies to minimize total claim costs. Experience in malpractice is preferred.

Formación

• 6 years of claims management experience or equivalent combo of education and experience.
• Bachelor's degree from an accredited college or university preferred.
• Licenses as required.
• Professional certification as applicable to line of business preferred.
• Work environment requirements include physical keyboarding, hearing, vision, and clear judgment.

Responsabilidades

• Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine exposure.
• Conducts or assigns full investigation and provides report of investigation.
• Calculates and assigns reserves to claims; monitors reserve adequacy.
• Recommends settlement strategies; proposes structured settlements when needed.
• Coordinates legal defense by assigning attorney and reviewing invoices; ensures compliance with guidelines.
• Uses cost containment techniques including vendor partnerships to reduce claim costs.
• Identifies fraud, subrogation, recovery opportunities to reduce total cost.
• Represents Company in depositions, mediations, and trial monitoring as needed.
• Communicates claim activity with the client and maintains professional relationships.
• Ensures files are properly documented and claims coding is correct.
• Performs other duties as assigned.

Conocimientos

Claims management experience

Negotiation skills

Analytical thinking

Educación

Bachelor's degree preferred

Licenses as required

Professional certification preferred

Descripción del empleo

Sedgwick is seeking a Sr. Claims professional to analyze complex medical malpractice claims and coordinate case management. You will resolve high-cost, high-exposure matters with strong analytical and negotiation skills, while delivering excellent customer service.

The role emphasizes managing reserves, coordinating legal defense, and applying cost-containment strategies to minimize total claim costs. Experience in malpractice is preferred.