Claims Specialist

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 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. 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 Physical: Computer keyboarding. Auditory/visual: Hearing, vision and talking. Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines. PAY & BENEFITS 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. EEO STATEMENTS Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. #J-18808-Ljbffr