Claims Specialist Sr - Professional Liability

$110,000 - $119,000/Yr

Sedgwick - Madison, WI

Full-time - Mid Level

Madison, WI

10,001+ employees

Insurance Carriers and Related Activities

About the position

The Claims Specialist Sr - Professional Liability at Sedgwick is responsible for analyzing and resolving complex medical malpractice claims. This role involves managing claims through action plans, conducting investigations, negotiating settlements, and ensuring compliance with client guidelines. The position emphasizes high levels of customer service while managing total claim costs and coordinating legal defense as necessary. The ideal candidate will have a strong background in claims management and a commitment to providing excellent service.

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 structured settlement proposals to maximize settlement.
• Coordinate legal defense by assigning attorneys and reviewing invoices; monitor compliance with client guidelines.
• Utilize 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 to supervisors and management as appropriate.
• Delegate work and mentor assigned staff.

Requirements

• Bachelor's degree from an accredited college or university preferred.
• Six years of claims management experience or equivalent combination of education and experience required.
• Excellent oral and written communication skills, including presentation skills.
• PC literate, including Microsoft Office products.
• Strong analytical and interpretive skills.
• Strong organizational skills and excellent negotiation skills.
• Good interpersonal skills and ability to work in a team environment.
• Ability to meet or exceed performance competencies.

Nice-to-haves

• Professional certification as applicable to line of business 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)
• Additional voluntary benefits