Senior Medical Malpractice Claims Strategist

Sedgwick; Austin (TX); 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

flexible spending or health savings账户

other additional voluntary benefits

Job summary

Sedgwick is seeking a Sr. Claims Specialist, Professional Liability to manage complex medical malpractice claims with high exposure in New Jersey. You will analyze cases, determine exposure, and guide outcomes with rigorous judgment and strong client service.

Ideal candidates bring 6 years of claims management experience, a bachelor's degree, and relevant certifications. You will coordinate defense, manage reserves, and ensure cost-effective resolutions while maintaining quality service.

Qualifications

• 6 years of claims management experience or equivalent.
• 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 action plans to resolution.
• Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and 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 cost containment techniques including vendor partnerships to reduce overall claim cost.
• Identifies and investigates fraud, subrogation, contribution, recovery opportunities.
• 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.
• Performs other duties as assigned.
• Supports the organization's quality program(s).

Skills

Claims management

Analytical skills

Negotiation skills

Customer service

Education

Bachelor's degree from an accredited college or university

Professional certification (if applicable)

Job description

Sedgwick is seeking a Sr. Claims Specialist, Professional Liability to manage complex medical malpractice claims with high exposure in New Jersey. You will analyze cases, determine exposure, and guide outcomes with rigorous judgment and strong client service.

Ideal candidates bring 6 years of claims management experience, a bachelor's degree, and relevant certifications. You will coordinate defense, manage reserves, and ensure cost-effective resolutions while maintaining quality service.