Senior Claims Specialist, Professional Liability

Sedgwick

Analyzing and processing complex medical malpractice claims at Sedgwick. Coordinating case management and ensuring high levels of customer service while managing costs.

Posted 6/17/2026full-timeRemote • New York • 🇺🇸 United StatesSenior💰 $87,497 - $129,000 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
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

What you’ll need

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
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 claimsinvestigation techniquessettlement negotiationclaims codingcost containment techniquesfraud investigationsubrogationcase managementreserve calculation

Soft Skills

oral communicationwritten communicationpresentation skillsorganizational skillsnegotiation skillsinterpersonal skillsteamworkanalytical skillsinterpretive skillsmentoring

Certifications

Bachelor's degreeprofessional certification