Senior Claims Specialist, Medical Malpractice

Sedgwick

Claims Specialist analyzing and processing complex medical malpractice claims. Managing resolution strategies and claims costs for a leading risk management firm.

Posted 5/8/2026full-timeRemote • California • 🇺🇸 United StatesSenior💰 $100,000 - $120,000 per yearWebsite

About the role

Key responsibilities & impact

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.
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.
Performs other duties as assigned.
Supports the organization's quality program(s).

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

medical
dental
vision
401k and matching
PTO
disability and life insurance
employee assistance
flexible spending or health savings account
other additional voluntary benefits

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims managementmedical malpractice claimsinvestigationreserve calculationsettlement strategiescost containment techniquesfraud investigationsubrogationcase managementclaims coding

Soft Skills

communicationclient relationship managementproblem-solvingorganizational skillsanalytical skillsnegotiationattention to detailteam coordinationprofessionalismadaptability

Certifications

professional certification