Senior Claims Specialist – Professional Liability

Sedgwick

Claims Specialist Sr responsible for analyzing and processing complex medical malpractice claims. Managing total claim costs while providing high levels of customer service within company standards.

Posted 6/16/2026full-timeRemote • Virginia • 🇺🇸 United StatesSenior💰 $76,085 - $125,000 per yearWebsite

About the role

Key responsibilities & impact

Analyzes and processes complex or technically difficult medical malpractice claims
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
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, recognizing opportunities to reduce total claim cost
Communicates claim activity and processing with the client
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

What you’ll need

Bachelor's degree from an accredited college or university preferred
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
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

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 claims analysisinvestigation reportingsettlement negotiationclaims codingreserve adequacy monitoringsettlement strategy recommendationlegal defense coordinationperformance competency assessmentanalytical skills

Soft Skills

oral communicationwritten communicationpresentation skillsorganizational skillsnegotiation skillsinterpersonal skillsteamworkmentoringdelegationproblem-solving

Certifications

Bachelor's degree