Sr. Claims Specialist, Professional Liability

$115,000 - $125,000/Yr

Sedgwick - Frankfort, KY

Full-time - Mid Level

Frankfort, KY

10,001+ employees

Insurance Carriers and Related Activities

About the position

The Sr. Claims Specialist, Professional Liability at Sedgwick is responsible for analyzing and resolving complex medical malpractice claims. This role involves managing claims through well-developed action plans, coordinating case management, and ensuring high levels of customer service while controlling claim costs. The position requires strong negotiation skills and the ability to work collaboratively with clients and legal teams to achieve favorable outcomes.

Responsibilities

• Analyzes and processes complex medical malpractice claims by investigating and gathering information to determine exposure.
• 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 and brings structured settlement proposals as necessary.
• Coordinates legal defense by assigning attorney and reviewing attorney invoices; monitors counsel for compliance with client guidelines.
• Uses cost containment techniques to reduce overall claim costs for clients.
• Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities.
• 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.

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.
• In-depth knowledge of medical malpractice insurance principles and laws.
• 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.

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 or health savings account
• Additional voluntary benefits