Claims Advisor, Professional Liability | Medical Malpractice

Sedgwick•Telecommuter NY, NY

1d•$100,000 - $125,000•Onsite

About The Position

This role involves managing and handling medical malpractice and professional liability claims, providing resolution for highly complex or severe injury claims. The Claims Advisor will coordinate case management within company standards, industry best practices, and specific client requirements, while managing total claim costs and maintaining high levels of customer service. Sedgwick is a global leader in risk and claims administration, helping clients navigate the unexpected with advanced AI-enabled technology and a team of over 33,000 colleagues across 80 countries.

Requirements

Ten (10) years of complex claims management experience or equivalent combination of education and experience required
Licenses as required.
In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business
Extensive knowledge and comprehension of insurance coverage
Claims expertise in medical malpractice, errors and omissions, directors and officers, life sciences, and/or cyber liability
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Excellent negotiation skills
Good interpersonal skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies
Computer keyboarding
Hearing, vision and talking
Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

Nice To Haves

Masters or Juris Doctorate degree from an accredited college or university preferred.
Designations and/or licensing including but not limited to Bachelor of Science in Nursing, Legal Nurse Consultant, Associate in Claims (AIC), Chartered Property and Casualty Underwriter (CPCU), Associate in Risk Management (ARM), Associate in Insurance Claims (AIC), Certified Professional in Health Care Risk Management (CPHRM) preferred.

Responsibilities

Analyzes and processes complex or technically difficult liability 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.
Negotiates claim settlement up to designated authority level.
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.
Performs coverage analysis and opinion as part of the claim process including all necessary correspondence.
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.
Delegates work and mentors others.