Claims Specialist Sr
2 days ago
Sedgwick is a leading global provider of technology-enabled risk, benefits, and integrated business solutions. As a Claims Specialist Sr - Professional Liability, you will play a critical role in analyzing complex medical malpractice claims, providing resolution, and managing total claim costs while delivering exceptional customer service.
Key Responsibilities- Analyze and process complex medical malpractice claims by investigating and gathering information to determine exposure.
- Manage claims through well-developed action plans to achieve timely and appropriate resolutions.
- 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 settlements.
- Coordinate legal defense by assigning attorneys, coordinating support for investigations, and reviewing attorney invoices.
- 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 accurate.
- Refer cases to supervisors and management as necessary.
- Delegate work and mentor assigned staff.
- 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 an equivalent combination of education and experience.
- Excellent judgment, troubleshooting, problem-solving, analysis, and discretion.
- Ability to handle work-related stress, multiple priorities simultaneously, and meet deadlines.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. We are committed to creating a diverse, equitable, and inclusive workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification, consider applying anyway. We recognize that each person possesses a unique combination of skills, knowledge, and experience.
Caring counts at Sedgwick. We take care of people at the heart of everything we do. Join us in making a positive impact on the world through the people and organizations we serve.
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