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

Sedgwick • Atlanta, GA • 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 | Medical Malpractice | Long Term Care

PRIMARY PURPOSE OF THE ROLE: To analyze complex or technically difficult medical malpractice claims including long term care facilities; 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. 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 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.

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. 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

Sr Healthcare AI Project Manager

Cayuse Holdings • Atlanta, GA • 24min ago

Hospital & Medical

Overview Job Title: Sr Project Manager - Healthcare AI Strategy Location: Hybrid - Atlanta, GA Job Type: Independent Contract (Contractor / Non-Employee) Start Date: October 19th Pay Rate: $100-$170 per hour (1099/C2C) -...

24min ago

Go to Apply

AI Engineering Lead- Director- Commercial Technology & Innovation

PwC • Atlanta, GA • 57min ago

Hospital & Medical

The Opportunity As an AI Engineering Lead, you will play a pivotal role in transforming raw data into actionable insights, enabling informed decision-making and driving business growth. Within our Advisory practice, you...

57min ago

Go to Apply

Operations Manager - Medical Records Retrieval (Remote)

Sharecare • Atlanta, GA • 1h ago

Hospital & Medical

Job Description: Sharecare is the leading digital health company that helps people - no matter where they are in their health journey - unify and manage all their health in one place. Our comprehensive and data-driven vi...

1h ago

Go to Apply

Licensed Practical Nurse

PruittHealth • Union City, GA • 2h ago

Hospital & Medical

LICENSED PRACTICAL NURSE Join the PruittHealth family, where the health and safety of our workforce is our top priority! We're not only committed to your career, we're committed to the health and safety of all our nurses...

2h ago

Go to Apply

Licensed Practical Nurse

PruittHealth • Lithonia, GA • 2h ago

Hospital & Medical

2h ago

Go to Apply

Registered Nurse Supervisor

PruittHealth • Union City, GA • 2h ago

Hospital & Medical

REGISTERED NURSE SUPERVISOR Join the PruittHealth family, where the health and safety of our workforce is our top priority! We're not only committed to your career, we're committed to the health and safety of all our nur...

2h ago

Go to Apply

Registered Nurse

PruittHealth • Lithonia, GA • 2h ago

Hospital & Medical

REGISTERED NURSE Join the PruittHealth family, where the health and safety of our workforce is our top priority! We're not only committed to your career, we're committed to the health and safety of all our nurses. Now is...

2h ago

Go to Apply

Registered Nurse

PruittHealth • Union City, GA • 2h ago

Hospital & Medical

2h ago

Go to Apply

The Perry Group: Health & Safety Professional 1 (heavy industrial, 100% travel)

CDM Smith • Atlanta, GA • 5h ago

Hospital & Medical

Company Overview The Perry Group, Ltd., a CDM Smith company, is a full-service, design-build, general construction and construction management firm. PGL provides full-service solutions - plant betterment, facilities and...

5h ago

Go to Apply

Medical Receptionist

CenterWell • Marietta, GA • 6h ago

Hospital & Medical

Become a part of our caring community As a Medical Receptionist, you will report to the Center Administrator. This is an onsite outpatient clinic setting for our Marietta Clinic. You will perform clinical duties such as:...

6h ago

Go to Apply

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