Claims Specialist, Professional Liability

2 days ago

Hartford CT United States Sedgwick Full time
Sedgwick Claims Specialist, Professional Liability Hartford, Connecticut

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.

A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

  1. Analyzes and processes complex or technically difficult liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
  2. Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.
  3. Negotiates claim settlement up to designated authority level.
  4. Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life.
  5. Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement.
  6. Performs coverage analysis and opinion as part of the claim process including all necessary correspondence.
  7. Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines.
  8. Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients.
  9. Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
  10. Represents company in depositions, mediations, and trial monitoring as needed.
  11. Communicates claim activity and processing with the client; maintains professional client relationships.
  12. Ensures claim files are properly documented and claims coding is correct.
  13. Refers cases as appropriate to supervisor and management.
  14. Delegates work and mentors others.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

  1. Performs other duties as assigned.
  2. Travels as required.

QUALIFICATIONS

Education & Licensing

Masters or Juris Doctorate degree from an accredited college or university preferred. Licenses as required. Designations and/or licensing including but not limited to Bachelor of Science in Nursing, Legal Nurse Consultant, Associate in Claims (AIC), Chartered Property and Casualty Underwriter (CPCU), Associate in Risk Management (ARM), Associate in Insurance Claims (AIC), Certified Professional in Health Care Risk Management (CPHRM) preferred.

Experience

Ten (10) years of complex claims management experience or equivalent combination of education and experience required.

Skills & Knowledge

  1. 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.
  2. Extensive knowledge and comprehension of insurance coverage.
  3. Claims expertise in medical malpractice, errors and omissions, directors and officers, life sciences, and/or cyber liability.
  4. Excellent oral and written communication, including presentation skills.
  5. PC literate, including Microsoft Office products.
  6. Analytical and interpretive skills.
  7. Strong organizational skills.
  8. Good interpersonal skills.
  9. Ability to work in a team environment.
  10. 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.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Taking care of people is at the heart of everything we do. Caring counts.

Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing – one where caring counts.

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