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 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, Professional Liability | Medical Malpractice | New York City, your primary purpose will be to 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.
Key responsibilities include:
- Analyzing and processing complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; managing claims through well-developed action plans to an appropriate and timely resolution.
- Conducting or assigning full investigation and providing report of investigation pertaining to new events, claims and legal actions.
- Negotiating claim settlement up to designated authority level.
- Calculating and assigning timely and appropriate reserves to claims; monitoring reserve adequacy throughout claim life.
- Recommending settlement strategies; bringing structured settlement proposals as necessary to maximize settlement.
- Coordinating legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitoring counsel for compliance with client guidelines.
- Using appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients.
- Identifying and investigating for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
- Representing Company in depositions, mediations, and trial monitoring as needed.
- Communicating claim activity and processing with the client; maintaining professional client relationships.
- Ensuring claim files are properly documented and claims coding is correct.
- Referring cases as appropriate to supervisor and management.
- Delegating work and mentoring assigned staff.
- Performing other duties as assigned.
- Supporting the organization's quality program(s).
Qualifications:
- Six (6) years of claims management experience or equivalent combination of education and experience required.
- Bachelor's degree from an accredited college or university.
- Juris Doctor preferred.
- Licenses as required.
- Professional certification as applicable to line of business preferred.
Skills and knowledge required:
- 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: Excel, Word, Teams.
- Analytical and interpretive skills.
- Strong organizational and time management skills.
- Excellent negotiation skills.
- Good interpersonal skills.
- Ability to work in a team environment.
- Ability to meet or exceed Performance Competencies.
Work environment requirements include:
- Physical: Computer keyboarding.
- Auditory/visual: Hearing, vision and talking.
- Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.
The salary range for this role is $120,000 to $135,000. 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.