Sr. Claims Specialist, Medical Malpractice | Professional Liability | California

Sr. Claims Specialist, Medical Malpractice | Professional Liability | California

Join Sedgwick as a Senior Claims Specialist in the Medical Malpractice—Professional Liability practice, working in California. Sedgwick is a global leader in risk management and claims solutions.

To analyze complex or technically difficult medical malpractice claims; provide resolution for highly complex or severe injury claims; coordinate case management within company standards and specific client service requirements; and manage total claim costs while providing high levels of customer service.

• Analyze and process complex medical malpractice claims by investigating and gathering information to determine exposure, manage claims through action plans to a timely resolution.
• Conduct or assign full investigations and provide reports on new events, claims and legal actions.
• Negotiate claim settlements up to designated authority level.
• Calculate and assign reserves, monitor reserve adequacy throughout claim life.
• Recommend settlement strategies; provide structured settlement proposals when necessary.
• Coordinate legal defense by assigning attorneys, coordinating support for investigations, and reviewing invoices; monitor counsel for compliance with client guidelines.
• Use cost containment techniques to reduce overall claim costs.
• Investigate fraud, subrogation, contribution, recovery, and case management opportunities.
• Represent the company in depositions, mediations, and trial monitoring as needed.
• Communicate claim activity to the client; maintain professional client relationships.
• Ensure claim files are properly documented and claims coding is correct.
• Refer cases to supervisors and management as appropriate.
• Delegate work and mentor staff.

Education & Licensing - Bachelor’s degree from an accredited college or university preferred; licensing as required; professional certification preferred.

Experience - Six (6) years of claims management experience or equivalent combination of education and experience.

• In-depth knowledge of medical malpractice insurance principles and laws, recoveries, offsets, and deductions.
• Understanding of claim and disability duration, cost containment principles, medical management practices, and Social Security application procedures.
• Excellent oral and written communication, including presentation skills.
• PC literacy, including Microsoft Office.
• Analytical and interpretive skills.
• Strong organizational skills.
• Excellent negotiation skills.
• Good interpersonal skills.
• Teamwork abilities.
• Ability to meet or exceed performance competencies.

Reasonable accommodations will be considered where applicable. The role may require computer keyboarding and travel as needed.

Mental:
Clear conceptual thinking, good judgment, problem solving, analysis, and discretion; handle stress, multiple priorities, and deadlines.

Physical:
Computer keyboarding, travel as required. Auditory/Visual:
Hearing, vision, and talking.

Credit security clearance may be required.

Starting pay range: $110,000 to $130,000.

A comprehensive benefits package includes medical, dental, vision, 401(k) and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other voluntary benefits.

Qualified applicants with arrest or conviction records will be considered in accordance with applicable Fair Chance Ordinances. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. Sedgwick encourages applicants who have a unique combination of skills and experience; arbitrary qualification references may be considered.