sedgwickNew York, NY
Sr. Claims Specialist, Professional Liability | Medical Malpractice | New York City
$120,000 to $135,000
Apply (opens in a new tab)Sr. Claims Specialist, Professional Liability | Medical Malpractice | New York City
Sr. Claims Specialist, Professional Liability | Medical Malpractice | New York City
sedgwickNew York, NY
yesterday
$120,000 to $135,000
Claims AdjustingAll Other Insurance Related ActivitiesDirect Property and Casualty Insurance Carriers
Apply for this role (opens in a new tab)Sr. Claims Specialist, Professional Liability | Medical Malpractice | New York City
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.
Essential Responsibilities Of The Role 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.
- 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 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.
- Delegates work and mentors assigned staff.
- Performs other duties as assigned.
- Supports the organization's quality program(s).
Qualifications:
Experience: Six (6) years of claims management experience or equivalent combination of education and experience required.
Education & Licensing:
- Bachelor's degree from an accredited college or university
- Juris Doctor preferred.
- Licenses as required.
- Professional certification as applicable to line of business preferred.
- Skills & Knowledge:
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 skillsPC literate, including Microsoft Office products: excel, word, teams
Analytical and interpretive skills
Strong organizational and time management skills
Excellent negotiation skills
Good interpersonal skills Ability to work in a team environment Ability to meet or exceed Performance Competencies
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 $120,000 to $135,000. 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.
Also on the board Same function, level within a rung
Level
Senior
Salary
$120,000 to $135,000
Location
New York, NY
Occupation
Claims Adjusters, Examiners, and Investigators
Industry
Claims Adjusting
Posted
yesterday