Sr. Claims Specialist, Professional Liability

$115,000 - $125,000/Yr

Sedgwick - Washington, DC

Full-time - Mid Level

Washington, DC

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 action plans, conducting investigations, negotiating settlements, and ensuring high levels of customer service while adhering to company standards and client requirements. The position requires a strong focus on cost management and collaboration with legal teams to effectively handle claims.

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 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.
• 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.
• Excellent negotiation skills and strong organizational 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 account (FSA) or health savings account (HSA)
• Additional voluntary benefits