Sr. Claims Specialist, Medical Malpractice | Professional Liability

Sedgwick • Alley, MO

5d

About The Position

The Sr. Claims Specialist analyzes complex or technically difficult medical malpractice claims and resolves highly complex or severe-injury claims. The role coordinates case management in accordance with company standards, industry best practices, and client service requirements, while managing total claim costs and providing high levels of customer service.

The specialist investigates claims, develops action plans, sets and monitors reserves, recommends settlement strategies, and coordinates legal defense. The role also applies cost-containment techniques, identifies opportunities for fraud investigation and recovery, represents the company in legal proceedings as needed, communicates with clients, and maintains accurate claim files and coding. The position supports the organization's quality programs.

Requirements

• Six years of claims management experience or an equivalent combination of education and experience.
• Licenses as required.
• Computer keyboarding.
• 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 timely and appropriate 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 develop structured settlement proposals as necessary to maximize settlement.
• Coordinate legal defense by assigning attorneys, supporting investigations, reviewing attorney invoices, and monitoring counsel compliance with client guidelines.
• Use cost-containment techniques, including strategic vendor partnerships, to reduce overall 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.
• Perform other duties as assigned.
• Support the organization's quality programs.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed