Licensed Auto Insurance Agent
Sedgwick
Claims Specialist, Professional Liability
Sedgwick
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $110,000 per year
Job Level
Mid-LevelSenior
About the role
- Analyze and process medical malpractice claims by limited investigating and gathering information to determine the exposure on the claim; manage claims through well-developed action plans to an appropriate and timely resolution
- Conduct or assign limited investigation and provide report of investigation pertaining to new events, claims and legal actions
- Negotiate claim settlement up to designated authority level
- Calculate and assign timely and appropriate reserves to claims; monitor reserve adequacy throughout claim life
- Recommend settlement strategies; bring structured settlement proposals as necessary to maximize settlement
- Coordinate legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitor counsel for compliance with client guidelines
- Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients
- Identify and investigate for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost
- Represent Company in depositions, mediations, and trial monitoring as needed
- Communicate claim activity and processing with the client; maintain professional client relationships
- Ensure claim files are properly documented and claims coding is correct
- Refer cases as appropriate to supervisor and management
- Perform other duties as assigned
- Support the organization's quality program(s)
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 related experience or equivalent combination of education and experience required to include three (3) years of claims management experience
- In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled
- Knowledge of 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
claims managementmedical malpractice claimscost containmentnegotiationinvestigationclaims codingfraud investigationreserve calculationsettlement strategieslegal compliance
Soft skills
communicationorganizational skillsanalytical skillsinterpersonal skillspresentation skillsteamworknegotiation skills
Certifications
Bachelor's degreeprofessional certification
