Claims Specialist Sr

2 days ago

Frankfort, Kentucky, United States Sedgwick Full time
About the Role

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.
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 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.
Work Environment

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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