Description
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're seeking experienced professionals to manage complex medical malpractice claims involving severe injury and high exposure. As a Sr. Claims Specialist, Professional Liability | Medical Malpractice | New Jersey Claims, 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.
Essential Responsibilities May Include:
- 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.
- 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 settlement.
- 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.
- Perform other duties as assigned.
- Support the organization's quality program(s).
Qualifications
- Education & Licensing: 6 years of claims management experience or equivalent combination of education and experience required.
- Bachelor's degree from an accredited college or university preferred. Licenses as required.
- Professional certification as applicable to line of business preferred.
Work Environment Requirements
- Physical: Computer keyboarding
- Auditory/visual: Hearing, vision and talking
- Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.
Compensation
- The range of starting pay for this role is $100,000 to $115,000.
- 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.