Claims Specialist, Professional Liability

$115,000 - $120,000/Yr

Sedgwick - Nashville, TN

Full-time - Senior

Nashville, TN

10,001+ employees

Insurance Carriers and Related Activities

About the position

The Claims Specialist, Professional Liability at Sedgwick is responsible for analyzing and processing complex liability claims, ensuring timely resolution through effective investigation and negotiation. This role involves managing claims, coordinating legal defense, and maintaining professional relationships with clients while adhering to company guidelines and best practices. The position emphasizes a culture of caring, flexibility, and support for personal and professional growth.

Responsibilities

• Analyzes and processes complex or technically difficult liability claims by investigating and gathering information to determine the exposure on the claim.
• 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.
• Performs coverage analysis and opinion as part of the claim process including all necessary correspondence.
• 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 others.

Requirements

• Masters or Juris Doctorate degree from an accredited college or university preferred.
• Ten (10) years of complex 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.
• Extensive knowledge and comprehension of insurance coverage.
• Claims expertise in medical malpractice, errors and omissions, directors and officers, life sciences, and/or cyber liability.
• 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.

Nice-to-haves

• Licenses as required.
• Designations and/or licensing including but not limited to Bachelor of Science in Nursing, Legal Nurse Consultant, Associate in Claims (AIC), Chartered Property and Casualty Underwriter (CPCU), Associate in Risk Management (ARM), Associate in Insurance Claims (AIC), Certified Professional in Health Care Risk Management (CPHRM) preferred.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• 401k and matching
• Paid time off (PTO)
• Disability insurance
• Life insurance
• Employee assistance program
• Flexible spending account (FSA) or health savings account (HSA)
• Other additional voluntary benefits