Sr. Claims Specialist, Professional Liability | Medical Malpractice

Sedgwick • Sacramento, CA • 2h ago

US Telecommuter

R80029

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

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. 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 to $125,000 . 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

Medical Assistant II, Pain Management

Sutter Health • Sacramento, CA • 10min ago

Hospital & Medical

We are so glad you are interested in joining Sutter Health! Organization: SMF-Sutter Med Foundation- Central Position Overview: Provides clinical and clerical support to providers and members of the patient care team(s)...

10min ago

Go to Apply

Medical Social Worker II

Sutter Health • Roseville, CA • 12min ago

Hospital & Medical

We are so glad you are interested in joining Sutter Health! Organization: SMCS-Valley Administration Position Overview: Provides biopsychosocial assessment, crisis intervention, short term counseling, advocacy, and linka...

12min ago

Go to Apply

Medical Assistant II, Pediatrics

Sutter Health • Lincoln, CA • 22min ago

Hospital & Medical

22min ago

Go to Apply

Medical Payment Poster Specialist

Robert Half • Sacramento, CA • 23min ago

Hospital & Medical

Description We are looking for a Medical Payment Poster Specialist to join a healthcare revenue cycle team in Sacramento, California. This contract position offers the potential for a permanent role and is fully in-offic...

23min ago

Go to Apply

Medical Collections Specialist

Robert Half • Sacramento, CA • 42min ago

Hospital & Medical

Description We are looking for a Medical Collections Specialist to support revenue cycle operations. This contract opportunity begins as leave coverage and offers the potential for long-term employment based on performan...

42min ago

Go to Apply

Clinical Content Associate Director - Clinical AI Scientific Evidence and Publications (UpToDate)

Wolters Kluwer • Sacramento, CA • 2h ago

Hospital & Medical

LOCATION: U.S. locations - remote/hybrid (8 days a month in the office). For physicians - Candidates within commuting distance of a Wolters Kluwer office will be considered for hybrid employment (within 50 miles of an of...

2h ago

Go to Apply

Physical Therapist (PT)

Amergis • Sacramento, CA • 8h ago

Hospital & Medical

Physical Therapist (PT) Setting: Healthcare Facilities Job Type: Travel Pay: $3004 / Week Hours: 40.00 Location: Sacramento, CA The Physical Therapist is responsible for performing patient evaluations, as well as providi...

8h ago

Go to Apply

Staff Pharmacist-Ca

Walmart • Rocklin, CA • 22h ago

Hospital & Medical

Position Summary... What you'll do... Are you ready to be at the forefront of patient care and make a impact in your community? As a Staff Pharmacist at Walmart, you will be empowered to share your clinical knowledge and...

22h ago

Go to Apply

Oracle Health Federal Senior Financial Analyst

Oracle • Sacramento, CA • 1d ago

Hospital & Medical

Job Description The Federal Consulting team at Oracle Health is seeking a Project Analyst to play a key role in driving operational excellence across our growing portfolio of federal healthcare clients. This position off...

1d ago

Go to Apply

Patient Account Assistant

Dignity Health • Rancho Cordova, CA • 1d ago

Hospital & Medical

Job Summary and Responsibilities As our Principal Patient Account Assistant, you will administer complex payable functions for Medicare risk contracts and commercial capitation. Every day you will calculate and submit re...

1d ago

Go to Apply

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