Claims Specialist Sr - Professional Liability

$110,000 - $119,000/Yr

Sedgwick - Boise, ID

Full-time - Mid Level

Boise, ID

10,001+ employees

Insurance Carriers and Related Activities

About the position

The Claims Specialist Sr - Professional Liability at Sedgwick is responsible for analyzing complex medical malpractice claims and providing resolutions for highly complex and severe injury claims. This role involves coordinating case management, managing total claim costs, and ensuring high levels of customer service while adhering to company standards and industry best practices. The position requires strong analytical skills, negotiation abilities, and effective communication to maintain professional relationships with clients and manage claims efficiently.

Responsibilities

• Analyze and process complex medical malpractice claims by investigating and gathering information to determine exposure.
• Conduct or assign full investigations and provide reports on new events, claims, and legal actions.
• Negotiate claim settlements up to designated authority level.
• Calculate and assign timely and appropriate reserves to claims; monitor reserve adequacy throughout claim life.
• Recommend settlement strategies and bring structured settlement proposals as necessary.
• Coordinate legal defense by assigning attorneys and reviewing invoices; monitor compliance with client guidelines.
• Use cost containment techniques to reduce overall claim costs for clients.
• Identify and investigate opportunities for fraud, subrogation, and recovery to reduce total claim costs.
• Represent the company in depositions, mediations, and trial monitoring as needed.
• Communicate claim activity and processing with clients; maintain professional 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.

Requirements

• Bachelor's degree from an accredited college or university preferred.
• Six (6) years of claims management experience or equivalent combination of education and experience required.
• Licenses as required; professional certification preferred.

Nice-to-haves

• Excellent oral and written communication skills, including presentation skills.
• PC literate, including Microsoft Office products.
• Strong organizational skills and analytical skills.
• Excellent negotiation and interpersonal skills.
• Ability to work in a team environment and meet performance competencies.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• 401k and matching
• Paid time off (PTO)
• Disability insurance
• Life insurance
• Employee assistance programs
• Flexible spending or health savings accounts
• Additional voluntary benefits