Sr. Claims Specialist, Professional Liability | Medical Malpractice | New York City
Sedgwick · NY, US
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About the Role
Analyze complex medical malpractice claims, provide resolution for severe injury claims, manage case coordination within company standards, and manage total claim costs while providing high levels of customer service.
Responsibilities
- Analyze and process complex or technically difficult medical malpractice claims by investigating and gathering information to determine exposure.
- Manage claims through well-developed action plans to an appropriate and timely resolution.
- Conduct or assign full investigation and provide a report of investigation pertaining to new events, claims, and legal actions.
- Negotiate claim settlement up to the designated authority level.
- Calculate and assign timely and appropriate reserves to claims and monitor reserve adequacy.
- Recommend settlement strategies and bring structured settlement proposals as necessary.
- Coordinate legal defense by assigning attorneys, 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.
- Identify and investigate for possible fraud, subrogation, contribution, recovery, and case management opportunities.
- Represent the Company in depositions, mediations, and trial monitoring as needed.
- Communicate claim activity and processing with the client and maintain professional client relationships.
- Ensure claim files are properly documented and claims coding is correct.
- Refer cases as appropriate to supervisor and management.
- Delegate work and mentor assigned staff.
- Perform other duties as assigned.
- Support the organization's quality program(s).
Requirements
- Six (6) years of claims management experience or equivalent combination of education and experience required.
Skills
- 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: excel, word, teams.
- Analytical and interpretive skills.
- Strong organizational and time management 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 judgement and discretion.
- Ability to meet deadlines.
Location
- New York City
Work Type
- Full-time
Experience Level
- 6 years of claims management experience
Education Level
- Bachelor's degree from an accredited college or university
- Juris Doctor preferred
- Licenses as required
- Professional certification as applicable to line of business preferred
Salary/Compensations
- $120,000 to $135,000
Benefits
- Medical
- Dental
- Vision
- 401k and matching
- PTO
- Disability and life insurance
- Employee assistance
- Flexible spending or health savings account
- Other additional voluntary benefits
About the Company
- Sedgwick is a company where colleagues work every day for people around the world who are facing the unexpected.
- Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies.
- Certified as a Great Place to Work®.
- Fortune Best Workplaces in Financial Services & Insurance.
Equal Opportunity
- Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
- Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience.