Sr. Claims Specialist, Medical Malpractice | Long Term Care | California

Sedgwick•Long Beach, CA

4d•Remote

About The Position

This role is for a Sr. Claims Specialist focusing on Medical Malpractice within the Long Term Care sector in California. The primary purpose is to analyze complex or technically difficult medical malpractice claims, provide resolution for highly complex or severe injury claims, coordinate case management within company standards and client requirements, and manage total claim costs while maintaining high customer service levels. The ideal candidate will have strong analytical and negotiation skills, sound judgment, and a commitment to timely, cost-effective claim resolutions.

Requirements

6 years of claims management experience or equivalent combination of education and experience required.
Licenses as required.
Computer keyboarding
Hearing, vision and talking
Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

Nice To Haves

Bachelor's degree from an accredited college or university preferred.
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).