Sr. Claims Specialist, Professional Liability | Medical Malpractice | Long Term Care

Sedgwick

2d•$105,000 - $120,000•Onsite

About The Position

This role is responsible for analyzing complex or technically difficult medical malpractice claims, focusing on Long Term Care clients. The specialist will provide resolution for highly complex claims or those involving severe injury, coordinate case management within company standards and industry best practices, and manage total claim costs while maintaining high levels of customer service. Sedgwick is a global leader in risk and claims administration, offering a caring culture and work-life balance, and has been recognized by Newsweek and Fortune for its workplaces.

Requirements

Six (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 for Long Term Care clients 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.
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 assigned staff.