Sr. Claims Specialist, Medical Malpractice | Remote

Sedgwick • Saint Paul, MN • 1h ago

US Telecommuter

Full time

R80208

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, Medical Malpractice | Remote

PRIMARY PURPOSE : 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.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

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.

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; brings structured settlement proposals as necessary to maximize settlements

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.

Delegates work and mentors assigned staff.

QUALIFICATIONS

Education & Licensing

Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred.

Experience

Six (6) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge

Performs other duties as assigned.

Supports the organization's quality program(s).

In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business

Excellent oral and written communication, including presentation skills

PC literate, including Microsoft Office products

Analytical and interpretive skills

Strong organizational skills

Excellent negotiation skills

Good interpersonal skills

Ability to work in a team environment

Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT

When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.

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 $110,000-$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

Sr. Claims Specialist, Medical Malpractice | Professional Liability

Sedgwick • Saint Paul, MN • 1h ago

Hospital & Medical

US Telecommuter R80526 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...

1h ago

Go to Apply

Acute Inpatient Patient Care Technician - PCT CCHT - Dialysis

Fresenius Medical Care • Coon Rapids, MN • 2h ago

Hospital & Medical

This PCT will work in 4 local hospitals on a rotating schedule 3 12- hour shifts weekly, 6:30am - 6:30pm PURPOSE AND SCOPE: Functions as part of the hemodialysis health care team in providing safe and effective dialysis...

2h ago

Go to Apply

Senior Product/Market Manager, Cardinal Health Brand Anatomic Pathology, Blood Bank, Hematology

Cardinal Health • Saint Paul, MN • 13h ago

Hospital & Medical

Country-wide Remote OH-Dublin-Cardinal Place US-Nationwide-FIELD Full time 20190616 Our Global Medical Products and Distribution business manufactures, sources, and distributes Cardinal Health branded medical, surgical,...

13h ago

Go to Apply

Mobile - Primary Care, MD - Medical Specialist 3

State of Minnesota • Anoka, MN • 14h ago

Hospital & Medical

Working Title: Medical Specialist 3 Job Class: Medical Specialist 3 Agency: Direct Care and Treatment Job ID : 98336 Location : Anoka Telework Eligible : No Full/Part Time : Full-Time Regular/Temporary : Unlimited Who Ma...

14h ago

Go to Apply

Staff Nurse (RN) - Surgical/ Trauma/ Neuro

Minnesota Visiting Nurse Agency • Minneapolis, MN • 17h ago

Hospital & Medical

JOB DETAILS Department: STNU FTE: 0.9 (72 hours per pay period) Number of shifts per pay period: 6 Shift(s): Nights Weekend rotation: every 3rd weekend Shift Length: 8 hours RESPONSIBILITIES: Within the @context of the H...

17h ago

Go to Apply

Staff Nurse (RN) - Surgical/ Trauma/ Neuro

Minnesota Visiting Nurse Agency • Minneapolis, MN • 17h ago

Hospital & Medical

JOB DETAILS Department: STNU FTE: 0.9 (72 hours per pay period) Number of shifts per pay period: 6 Shift(s): Days/Nights Weekend rotation: Every 3rd Weekend Shift Length: 12 hours Call: N/A RESPONSIBILITIES: Within the @...

17h ago

Go to Apply

Staff Nurse (RN) - Inpatient Medicine

Minnesota Visiting Nurse Agency • Minneapolis, MN • 17h ago

Hospital & Medical

JOB DETAILS Department: Inpatient Medicine FTE: 0.8 (64 hours per pay period) Number of shifts per pay period: 8 Shift(s): Days/Evenings Weekend rotation: Every other Weekend Shift Length: 8 hours Call: N/A RESPONSIBILIT...

17h ago

Go to Apply

Staff Nurse (RN) - Inpatient Medicine

Minnesota Visiting Nurse Agency • Minneapolis, MN • 17h ago

Hospital & Medical

JOB DETAILS Department:Inpatient Medicine FTE: 0.7 (56 hours per pay period) Number of shifts per pay period: 7 Shift(s): Nights Weekend rotation: Every other weekend Shift Length: 8 hours Call: N/A RESPONSIBILITIES: Wit...

17h ago

Go to Apply

Healthcare Finance & Performance Analytics Manager

Huron Consulting Group • Minneapolis, MN • 21h ago

Hospital & Medical

Remote Chicago - 550 Van Buren North Carolina Columbus - 375 N Front Street Denver - 1331 17th Georgia Tennessee Washington DC - 1800 M Street, NW Boston - 225 Franklin St Minnesota Pennsylvania-Philadelphia Houston - 29...

21h ago

Go to Apply

Medical Device Assembler

ManpowerGroup • Plymouth, MN • 23h ago

Hospital & Medical

This role is with a leading medical device manufacturing organization, is seeking Operators to join their team. As an Operator, you will be part of the manufacturing support team, contributing to the production of high-q...

23h ago

Go to Apply

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