Claims Specialist, Professional Liability Expert
4 days ago
Sedgwick is seeking a highly skilled Claims Specialist, Professional Liability to join our team. As a key member of our risk management team, you will be responsible for analyzing and processing complex liability claims, managing claims through well-developed action plans, and negotiating claim settlements.
Key Responsibilities- Analyze and process complex liability claims, including investigating and gathering information to determine exposure and managing claims through well-developed action plans.
- Conduct or assign full investigations and provide reports of investigation pertaining to 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 as necessary to maximize settlement.
- Perform coverage analysis and opinion as part of the claim process, including all necessary correspondence.
- Coordinate legal defense by assigning attorneys, coordinating support for investigation, and reviewing attorney invoices, monitoring counsel for compliance with client guidelines.
- Use appropriate cost containment techniques, including strategic vendor partnerships, to reduce overall claim cost for clients.
- Identify and investigate potential fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
- Represent the company in depositions, mediations, and trial monitoring as needed.
- Communicate claim activity and processing with clients, maintaining professional client relationships.
- Ensure claim files are properly documented and claims coding is correct.
- Refer cases as appropriate to supervisors and management.
- Delegate work and mentor others.
- 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.
- Ten (10) years of complex claims management experience or equivalent combination of education and experience 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.
- Extensive knowledge and comprehension of insurance coverage.
- Claims expertise in medical malpractice, errors and omissions, directors and officers, life sciences, and/or cyber liability.
- 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.
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.
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