Senior Medical Malpractice Claims Specialist — Complex

Sedgwick; Bristol (RI); On-site; USD 95,000 - 120,000; Full time

Job summary

Sedgwick in the United States is seeking a Sr. Claims Specialist for Professional Liability / Medical Malpractice to analyze complex claims and coordinate resolution.

Ideal candidates have strong analytical and negotiation skills, experience managing high‑exposure medical malpractice claims, and a commitment to accuracy and client service.

This role emphasizes reserves, settlement strategies, and collaboration with attorneys to control costs while delivering timely responses.

Qualifications

• 6 years of claims management experience or equivalent combination 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.

Responsibilities

• Analyzes and processes complex medical malpractice claims and manages claims through well-developed action plans to a 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

Negotiation

Analytical thinking

Client service

Education

Bachelor's degree (preferred)

Job description

Sedgwick in the United States is seeking a Sr. Claims Specialist for Professional Liability / Medical Malpractice to analyze complex claims and coordinate resolution.

Ideal candidates have strong analytical and negotiation skills, experience managing high‑exposure medical malpractice claims, and a commitment to accuracy and client service.

This role emphasizes reserves, settlement strategies, and collaboration with attorneys to control costs while delivering timely responses.