Sr. Claims Specialist, Professional Liability | Medical Malpractice

Sedgwick Claims Management Services Ltd; United States; On-site; USD 65,000 - 90,000; Full time

Job summary

Sedgwick Claims Management Services Ltd is seeking a Sr. Claims Specialist in Professional Liability/Medical Malpractice to analyze and resolve highly complex claims with severe injury and high exposure. You will coordinate case management, develop action plans, and support cost containment for clients.

The ideal candidate has 6+ years in claims management, a Bachelor's degree, and professional certifications as applicable. Strong judgment and client-focused service are essential in this role.

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 medical malpractice claims; investigates and gathers information to determine exposure and manages claims to timely resolution.
• Conducts full investigations and provides reports pertaining to new events, claims and legal actions.

Skills

Analytical skills

Negotiation skills

Sound judgment

Education

Bachelor's degree

Job description

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.