Senior Claims Specialist – Professional Liability, Long Term Care, Medical Malpractice

Sedgwick

Analyze complex medical malpractice claims and manage resolutions while ensuring high customer service. Coordinate case management according to company standards and industry best practices.

Posted 5/6/2026full-timeRemote • Florida, New York, Ohio, Virginia • 🇺🇸 United StatesSenior💰 $100,000 - $120,000 per yearWebsite

About the role

Key responsibilities & impact

To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims.
To coordinate case management within Company standards, industry best practices and specific client service requirements.
To manage the total claim costs while providing high levels of customer service.
Analyzes and processes complex or technically difficult medical malpractice and long term care claims by investigating and gathering information to determine the exposure on the claim.
Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.
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.

Requirements

What you’ll need

6 years of claims management experience or equivalent combination of education and experience required.
Bachelor's degree from an accredited college or university preferred.
Licenses as required.
Professional certification as applicable to line of business preferred.

Benefits

Comp & perks

Flexible work schedule.
Referral incentive program.
Career development and promotional growth opportunities.
A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

claims managementmedical malpractice claims analysislong term care claims processinginvestigation techniquesreserve calculationsettlement strategy recommendationcost containment techniquesfraud investigationsubrogationclaims coding

Soft Skills

customer servicecommunicationprofessional relationship managementcoordinationproblem-solvinganalytical thinkingnegotiationattention to detailleadershipteam collaboration

Certifications

professional certification in claims managementlicenses as required