Senior Medical Malpractice & Professional Liability Claims

Sedgwick; Alabama; On-site; USD 70,000 - 90,000; Full time

Job summary

Sedgwick is seeking a Senior Claims Specialist in Medical Malpractice to analyze complex claims, manage high-exposure cases, and coordinate case work with clients and internal teams.

Ideal candidates bring 6 years of claims management experience, a Bachelor's degree, and strong analytical and negotiation skills to deliver timely, cost-effective resolutions while maintaining a high level of customer service. This role emphasizes teamwork, client-focused outcomes, and adherence to guidelines.

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 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).

Education

Bachelor's degree

Job description

Sedgwick is seeking a Senior Claims Specialist in Medical Malpractice to analyze complex claims, manage high-exposure cases, and coordinate case work with clients and internal teams.

Ideal candidates bring 6 years of claims management experience, a Bachelor's degree, and strong analytical and negotiation skills to deliver timely, cost-effective resolutions while maintaining a high level of customer service. This role emphasizes teamwork, client-focused outcomes, and adherence to guidelines.