Senior Claims Specialist

4 days ago

Jefferson City, Missouri, United States Sedgwick Full time

At Sedgwick, we're committed to delivering exceptional service and expertise to our clients. As a Senior Claims Specialist, you'll play a critical role in analyzing complex medical malpractice claims and providing resolution through well-developed action plans.

Key Responsibilities:

  • Analyze and process complex medical malpractice claims, investigating and gathering information to determine exposure and manage claims to an appropriate and timely resolution.
  • Conduct or assign full investigations and provide reports on new events, claims, and legal actions.
  • Negotiate claim settlements up to designated authority levels.
  • Calculate and assign timely and appropriate reserves to claims, monitoring reserve adequacy throughout the claim life.
  • Recommend settlement strategies and bring structured settlement proposals to maximize settlement.
  • Coordinate legal defense by assigning attorneys, coordinating support for investigations, and reviewing attorney invoices, monitoring counsel for compliance with client guidelines.
  • Use cost containment techniques, including strategic vendor partnerships, to reduce overall claim costs for clients.
  • Identify and investigate potential fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim costs.
  • Represent the company in depositions, mediations, and trial monitoring as needed.
  • Communicate claim activity and processing with clients, maintaining professional relationships.
  • Ensure claim files are properly documented and claims coding is correct.
  • Refer cases to supervisors and management as appropriate.
  • Delegate work and mentor assigned staff.

Requirements:

  • Bachelor's degree from an accredited college or university preferred.
  • Licenses as required.
  • Professional certification applicable to the line of business preferred.
  • Six (6) years of claims management experience or equivalent combination of education and experience required.
  • In-depth knowledge of medical malpractice insurance principles and laws, recoveries, offsets, and deductions, claim and disability duration, cost containment principles, and medical management practices.
  • 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.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

As a Senior Claims Specialist at Sedgwick, you'll have the opportunity to work in a dynamic and supportive environment, collaborating with a talented team to deliver exceptional results for our clients. If you're passionate about claims management and have a strong background in medical malpractice, we encourage you to apply for this exciting opportunity.

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