Sr. Claims Specialist, Professional Liability | Medical Malpractice

Sedgwick

5d•$100,000 - $125,000

About The Position

The Sr. Claims Specialist analyzes complex or technically difficult medical malpractice claims, including severe-injury and high-exposure cases. The role coordinates case management within company standards, industry best practices, and client service requirements, while managing claim costs and delivering high levels of customer service. The specialist investigates claims, develops action plans, determines and monitors reserves, recommends settlement strategies, coordinates legal defense, and pursues cost-containment and recovery opportunities. The role also maintains client relationships, documents claim files, and supports organizational quality programs.

Requirements

Six years of claims management experience, or an equivalent combination of education and experience.
Licenses as required.
Ability to keyboard on a computer.
Hearing, vision, and talking abilities.
Clear and conceptual thinking ability, excellent judgment and discretion, and ability to meet deadlines.

Nice To Haves

Bachelor's degree from an accredited college or university.
Professional certification applicable to the line of business.

Responsibilities

Analyze and process complex or technically difficult medical malpractice claims by investigating and gathering information to determine claim exposure, then manage claims through action plans to appropriate and timely resolution.
Conduct or assign full investigations and prepare investigation reports concerning new events, claims, and legal actions.
Calculate and assign timely, appropriate reserves and monitor reserve adequacy throughout the life of each claim.
Recommend settlement strategies and present structured settlement proposals as appropriate.
Coordinate legal defense, including assigning attorneys, supporting investigations, reviewing attorney invoices, and monitoring counsel for compliance with client guidelines.
Use cost-containment techniques, including strategic vendor partnerships, to reduce overall client claim costs.
Identify and investigate potential fraud, subrogation, contribution, recovery, and case-management opportunities to reduce total claim costs.
Represent the company in depositions and mediations, and monitor trials as needed.
Communicate claim activity and processing to clients and maintain professional client relationships.
Ensure claim files are properly documented and claim coding is correct.
Refer cases to a supervisor or management as appropriate.
Support the organization's quality programs.
Perform other duties as assigned.