Sr. Claims Specialist, Professional Liability | Long Term Care | Medical Malpractice

Sedgwick • Austin, TX • 2h ago

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.

Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies

Certified as a Great Place to Work®

Fortune Best Workplaces in Financial Services & Insurance

Sr. Claims Specialist, Professional Liability | Long Term Care | Medical Malpractice

Job Description

PRIMARY PURPOSE OF THE ROLE: To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service.

ARE YOU AN IDEAL CANDIDATE?

We are seeking experienced professionals to manage complex medical malpractice claims involving severe injury and high exposure, will be handling long term care claims. Ideal candidates demonstrate strong analytical and negotiation skills, exercise sound judgment, and are committed to delivering timely, cost-effective claim resolutions while maintaining a high level of customer service.

ESSENTIAL RESPONSIBLITIES MAY INCLUDE:

Analyzes and processes complex or technically difficult medical malpractice and long term care claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.

Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.

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.

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.

Performs other duties as assigned.

Supports the organization's quality program(s).

QUALIFICATIONS

Education & Licensing: 6 years of claims management experience or equivalent combination of education and experience required.

Bachelor's degree from an accredited college or university preferred. Licenses as required.

Professional certification as applicable to line of business preferred.

TAKING CARE OF YOU

Flexible work schedule.

Referral incentive program.

Career development and promotional growth opportunities.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Work environment requirements include -

Physical: Computer keyboarding

Auditory/visual: Hearing, vision and talking

Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $100,000 to $120,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com

Similar Jobs

Key Accounts Manager, Clinical Diagnostics

ThermoFisher Scientific • Austin, TX • 2h ago

Hospital & Medical

Work Schedule Standard (Mon-Fri) Environmental Conditions Office Job Description As part of the Thermo Fisher Scientific team, you'll discover meaningful work that makes a positive impact on a global scale. Join our coll...

2h ago

Go to Apply

Licensed Pharmacist

Specialty Rx, Inc. • Austin, TX • 5h ago

Hospital & Medical

Job Description Our Company SpecialtyRx is a Long-Term Care pharmacy providing pharmaceutical services to long term care facilities and assisted living communities. SpecialtyRx takes pride in delivering personalized care...

5h ago

Go to Apply

Clinical Operations Manager - Finance - Remote

Merck • Austin, TX • 7h ago

Hospital & Medical

Job Description This role is accountable for performance and compliance for assigned protocols in a country in compliance with ICH/GCP and country regulations, our company policies and procedures, quality standards and a...

7h ago

Go to Apply

Physical Therapist, Home Health

CenterWell • Austin, TX • 8h ago

Hospital & Medical

Become a part of our caring community As a fulltime therapist at CenterWell Home Health, reporting to the Clinical Manager, you will help patients regain strength, mobility and independence, from the comfort of their hom...

8h ago

Go to Apply

Account Executive - Home Health

BrightSpring Health Services • Austin, TX • 16h ago

Hospital & Medical

Our Company Adoration Home Health and Hospice Overview Are you looking for a new marketing opportunity?Adoration Home Healthis seeking a passionate, dedicated Home HealthAccount Executiveto join our team in?Austin, TX. O...

16h ago

Go to Apply

Application Analyst- Patient Access

Intermountain Health • Austin, TX • 1d ago

Hospital & Medical

Job Description: This position is responsible for standard level work supporting Patient Access information technology application(s) through planning, designing, implementing, maintaining, and providing ongoing optimiza...

1d ago

Go to Apply

Medical Consultant- Psychiatrist

Unum Group • Austin, TX • 1d ago

Hospital & Medical

When you join the team at Unum, you become part of an organization committed to helping you thrive. Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to th...

1d ago

Go to Apply

Patient Service Specialist - Medical Front Office

Select Medical • Austin, TX • 1d ago

Hospital & Medical

Overview Baylor Scott & White Institute for Rehabilitation Austin, TX (North Austin Clinic) Patient Service Specialist (PSS) - Float Hours: vary M- F between 7am - 7pm PRN (as needed) Candidate will be required to tr...

1d ago

Go to Apply

Operating Room Nurse

HCA Healthcare • Round Rock, TX • 1d ago

Hospital & Medical

As a Operating Room Nurse, your voice to influence patient care is valued and empowered at every turn -whether through open, collaborative relationships with your direct manager or more formal opportunities through hospi...

1d ago

Go to Apply

Acute Care General Surgeon, Pflugerville

Baylor Scott & White Health • Pflugerville, TX • 1d ago

Hospital & Medical

Joining Baylor Scott & White Health means more than starting a new job - it means answering a calling that is both fulfilling and rewarding. Our physician-led culture thrives on collaboration, innovation, and a share...

1d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)