Sr. Claims Specialist, Professional Liability | Medical Malpractice | California

Sedgwick•Long Beach, CA

5d•$100,000 - $125,000

About The Position

The Sr. Claims Specialist, Professional Liability | Medical Malpractice | California analyzes complex or technically difficult medical malpractice claims, including severe injury and high-exposure 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 a high level of customer service. The position involves investigating claims, evaluating exposure, developing action plans, establishing and monitoring reserves, recommending settlement strategies, coordinating legal defense, and pursuing cost-containment and recovery opportunities. The specialist communicates claim activity to clients, maintains professional relationships, documents files accurately, and supports the organization’s quality programs.

Requirements

Six years of claims management experience, or an equivalent combination of education and experience.
Licenses as required.
Ability to use a computer keyboard.
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, and manage claims through action plans to 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 develop structured settlement proposals as necessary to maximize settlement.
Coordinate legal defense by assigning attorneys, supporting investigations, reviewing attorney invoices, and monitoring counsel’s compliance with client guidelines.
Use cost-containment techniques, including strategic vendor partnerships, to reduce clients’ 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.