Claims Specialist, Professional Liability – Medical Malpractice
Sedgwick
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $117,000 - $125,000 per year
About the role
- Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
- Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.
- Negotiates claim settlement up to designated authority level.
- Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life.
- Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement.
- Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines.
- Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients.
- Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
- Represents Company in depositions, mediations, and trial monitoring as needed.
- Communicates claim activity and processing with the client; maintains professional client relationships.
- Ensures claim files are properly documented and claims coding is correct.
- Refers cases as appropriate to supervisor and management.
- Delegates work and mentors assigned staff.
Requirements
- Bachelor's degree from an accredited college or university preferred
- Licenses as required
- Professional certification as applicable to line of business preferred
- Six (6) years of 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
- 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
Benefits
- medical
- dental
- vision
- 401k and matching
- PTO
- disability and life insurance
- employee assistance
- flexible spending or health savings account
- other additional voluntary benefits
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims managementmedical malpractice claimscost containment techniquessettlement strategiesfraud investigationsubrogationcase managementclaims codingreserve calculationlegal compliance
Soft Skills
oral communicationwritten communicationpresentation skillsanalytical skillsorganizational skillsnegotiation skillsinterpersonal skillsteamworkmentoringdelegation
Certifications
professional certificationlicenses