Sr. Claims Specialist, Professional Liability | Medical Malpractice | New JerseyClaims

Sedgwick; Providence (RI); Sur place; USD 100 000 - 115 000; Plein temps

Avantages offerts par ce poste

Medical

Dental

Vision

401k and matching

PTO

Disability and life insurance

Employee assistance

FSA/HSA

Voluntary benefits

Résumé du poste

Sedgwick is seeking a Sr. Claims Specialist to analyze and resolve complex medical malpractice claims with a focus on severe exposure and cost-effective outcomes.

You will coordinate investigations, manage reserves, and collaborate with legal teams and clients to deliver timely resolutions. The role requires strong analytical and negotiation skills, adherence to client guidelines, and commitment to high-quality service.

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 exposure; manages claims through well-developed action plans to resolution.
• Conducts or assigns full investigation and provides reports of investigation pertaining to new events, claims and legal actions.
• Calculates and assigns timely reserves; 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 invoices; monitors counsel for client guidelines compliance.
• Uses cost containment techniques including strategic vendor partnerships to reduce overall claim costs.
• Identifies and investigates fraud, subrogation, contribution, recovery 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 to supervisor and management when appropriate.
• Performs other duties as assigned and supports the organization's quality programs.

Formation

Bachelor's degree from an accredited college or university preferred

Description du poste

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 CompaniesCertified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance

Sr. Claims Specialist, Professional Liability | Medical Malpractice | New Jersey Claims

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 keyboardingAuditory/visual: Hearing, vision and talkingMental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $100,000 to $115,000.

A comprehensive benefits package is offered including but not limited to:

• medical
• dental
• vision
• 401k and matching
• PTO
• disability and life insurance
• employee assistance
• flexible spending or health savings account
• other additional voluntary benefits

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.