Senior Medical Malpractice Claims Strategist

Sedgwick; Rhode Island; Sur place; USD 85 000 - 110 000; Plein temps

Résumé du poste

Sedgwick is seeking a Sr. Claims Specialist in Rhode Island to analyze complex medical malpractice claims, coordinate case management, and resolve high-exposure cases with strong customer service.

You will manage reserves, propose settlements, and work with defense attorneys within client guidelines. The role requires at least 6 years in claims management, a bachelor’s degree, and professional certifications as applicable.

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.

Responsabilités

• Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and 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).

Connaissances

Claims management experience

Analytical skills

Negotiation skills

Formation

Bachelor's degree from an accredited college or university

Description du poste

Sedgwick is seeking a Sr. Claims Specialist in Rhode Island to analyze complex medical malpractice claims, coordinate case management, and resolve high-exposure cases with strong customer service.

You will manage reserves, propose settlements, and work with defense attorneys within client guidelines. The role requires at least 6 years in claims management, a bachelor’s degree, and professional certifications as applicable.