Senior Medical Malpractice Claims Strategist

Sedgwick Claims Management Services; Texas; Hybrid; USD 100,000 - 115,000; Full time

Benefits offered by this job

Medical, dental, vision

401k with company matching

Paid time off (PTO)

Disability and life insurance

Employee assistance

HSA/FP

Job summary

Sedgwick is seeking a Sr. Claims Specialist, Professional Liability to analyze complex medical malpractice claims and coordinate case management for New Jersey claims.

You will work to resolve highly complex cases with strong customer service. Ideal candidates bring extensive claims management experience, analytical and negotiation skills, and the ability to manage reserves, settlements, and litigation coordination within client guidelines.

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 on the claim; 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 reserves; monitors reserve adequacy throughout claim life.
• Recommends settlement strategies; proposes structured settlement options to maximize settlement.
• Coordinates legal defense by assigning attorney and reviewing invoices; ensures compliance with client guidelines.
• Uses cost containment techniques including vendor partnerships to reduce total claim cost for clients.
• Identifies opportunities for fraud, subrogation, recovery, and case management to reduce total cost.
• Represent 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.

Skills

Analytical skills

Negotiation skills

Claims management

Education

Bachelor's degree

Job description

Sedgwick is seeking a Sr. Claims Specialist, Professional Liability to analyze complex medical malpractice claims and coordinate case management for New Jersey claims.

You will work to resolve highly complex cases with strong customer service. Ideal candidates bring extensive claims management experience, analytical and negotiation skills, and the ability to manage reserves, settlements, and litigation coordination within client guidelines.