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Company

Sedgwick · 9 hours ago

Professional Liability Claims Advisor | Remote (Must Reside in California)

California, United States

Full-time

Remote

Mid, Senior Level

$100K/yr - $140K/yr

6+ years exp

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BankingInsurance

No H1B

Security Clearance Required

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Responsibilities

Analyzes and processes complex or technically difficult medical professional liability 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 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 others.

Performs other duties as assigned.

Travels as required.

Qualification

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Medical malpractice claims managementClaims expertiseCost containment principlesMicrosoft Office proficiency

Required

Bachelor's degree from an accredited college or university

MEDMAL defense or MedMal claims handling experience

In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled

Claims expertise in medical malpractice

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

Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Computer keyboarding, travel as required

Hearing, vision and talking

Credit security clearance, confirmed via a background credit check