Sr. Claims Specialist, Medical Malpractice

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.

As a Sr. Claims Specialist, Medical Malpractice, you will analyze complex or technically difficult medical malpractice claims, provide resolution of highly complex nature and/or severe injury claims, coordinate case management within Company standards, industry best practices and specific client service requirements, and manage the total claim costs while providing high levels of customer service.

Responsibilities:

• Analyze and process complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manage claims through well-developed action plans to an appropriate and timely resolution.
• Conduct or assign full investigation and provide report of investigation pertaining to new events, claims and legal actions.
• Negotiate claim settlement up to designated authority level.
• Calculate and assign timely and appropriate reserves to claims; monitor reserve adequacy throughout claim life.
• Recommend settlement strategies; bring structured settlement proposals as necessary to maximize settlements.
• Coordinate legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitor counsel for compliance with client guidelines.
• Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients.
• Identify and investigate for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
• Represent Company in depositions, mediations, and trial monitoring as needed.
• Communicate claim activity and processing with the client; maintain professional client relationships.
• Ensure claim files are properly documented and claims coding is correct.
• Refer cases as appropriate to supervisor and management.
• Delegate work and mentor assigned staff.

Qualifications:

• Bachelor's degree from an accredited college or university preferred.
• Licenses as required.
• Professional certification as applicable to line of business preferred.
• Six (6) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge:

• In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business.
• Excellent oral and written communication, including presentation skills.
• PC literate, including Microsoft Office products.
• Analytical and interpretive skills.
• Strong organizational skills.
• Excellent negotiation skills.
• Good interpersonal skills.
• Ability to work in a team environment.
• Ability to meet or exceed Performance Competencies.

Work Environment:

• When applicable and appropriate, consideration will be given to reasonable accommodations.
• Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
• Physical: Computer keyboarding, travel as required.
• Auditory/Visual: Hearing, vision and talking.

Salary: The range of starting pay for this role is $110,000-$120,000.

Benefits: A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.