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Sedgwick · 10 hours ago

PL CLAIM SPECIALIST

United States

Full-time

Remote

Mid, Senior Level

$117K/yr - $125K/yr

6+ years exp

Sedgwick is a company dedicated to providing support to individuals facing unexpected challenges. The PL Claim Specialist role involves analyzing complex medical malpractice claims, coordinating case management, and managing claim costs while ensuring high levels of customer service.

BankingInsuranceRisk Management

Responsibilities

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

Performs other duties as assigned

Supports the organization's quality program(s)

Qualification

Medical malpractice knowledgeClaims management experienceAnalytical skillsCost containment principlesNegotiation skillsPC literacyOral communicationWritten communicationInterpersonal skillsOrganizational skillsTeamwork abilityPresentation skills

Required

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, 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