Sr. Claims Specialist, Professional Liability | Medical Malpractice

American Association of Legal Nurse Consultants (AALNC); Chelsea (MI); On-site; USD 70,000 - 100,000; Full time

Job summary

Sedgwick is hiring for a Sr. Claims Specialist, Professional Liability | Medical Malpractice in the United States. You will analyze complex medical malpractice claims, manage cost-effective resolutions, and coordinate case management to meet client service requirements.

Ideal candidates bring strong analytical and negotiation skills, sound judgment, and a commitment to timely, high-quality claim resolutions with exceptional customer service.

Qualifications

• 6 years of claims management experience or equivalent combination of education and experience.
• Bachelor's degree 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 reports of investigation for new events, claims and legal actions.
• Calculates and assigns timely reserves; monitors reserve adequacy throughout the claim life.
• Recommends settlement strategies and proposes structured settlements to maximize recovery.
• Coordinates legal defense by assigning attorneys, coordinating support for investigation, and reviewing attorney invoices.
• Uses cost containment techniques including vendor partnerships to reduce overall claim cost.
• Identifies and investigates fraud, subrogation, contribution, and recovery opportunities.
• Represents the Company in depositions, mediations, and trial monitoring as needed.
• Keeps client updated on claim activity and maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases to supervisor and management as appropriate.
• Performs other duties as assigned; supports the organization's quality programs.

Skills

Analytical skills

Negotiation skills

Judgment

Customer service orientation

Education

Bachelor's degree

Licenses as required

Professional certification applicable to line of business

Job description

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Sr. Claims Specialist, Professional Liability | Medical Malpractice

PRIMARY PURPOSE OF THE ROLE:

To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service.

ARE YOU AN IDEAL CANDIDATE?

We are seeking experienced professionals to manage complex medical malpractice claims involving severe injury and high exposure. Ideal candidates demonstrate strong analytical and negotiation skills, exercise sound judgment, and are committed to delivering timely, cost-effective claim resolutions while maintaining a high level of customer service.

Essential Responsiblities May Include

• 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).

Qualifications

Education & Licensing: 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.

Work Environment Requirements Include -

• Physical: Computer keyboarding
• Auditory/visual: Hearing, vision and talking
• Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.