Sedgwick

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Claims Specialist Sr - PL

at Sedgwick

Posted: 10/6/2019
Job Status: Full Time
Job Reference #: J3V7V066L2BMQHPHSJ4
Categories: Insurance
Keywords: insurance, claims

Job Description

Claims Specialist Sr - Professional Liability

IF YOU CARE, THERE'S A PLACE FOR YOU HERE

For a career path that is both challenging and rewarding, join Sedgwick's talented team of 21,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assets -- their employees, their customers and their property. At Sedgwick, caring counts®. Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others.

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 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.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

  • Performs other duties as assigned.
  • Supports the organization's quality program(s).

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

  • 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.

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

#monster

Sedgwick Claims Management Services, Inc.is the leader in innovative claims and productivity management solutions to major employers. We provide cost-effective claims administration, managed care, program management and related services through the expertise of over 10,000 in 190+ offices and service locations. We are the largest, most innovative Third Party Administrator in the claims industry and the first and only TPA to receive recognition both as the “Best TPA in America” and “Employer of Choice.”

Sedgwick unique positioning allows you to “Claim Your Future.” We provide satisfying, challenging work along with a highly professional, friendly work atmosphere. We strive to make Sedgwick a place where great people can do great things for our clients. We express this commitment through our colleague development program, multi-dimensional learning resources, and commitment to work-life balance. Sedgwick offers exceptional benefits, including:

  • Competitive compensation
  • Comprehensive benefits (day one health benefits, STD, LTD, Life, 401(k) plus match, EAP, generous vacation and PTO)
  • Flexible work schedules

If you desire a company where you can positively influence lives while maximizing your own career possibilities, Sedgwick is the place for you. Join our Talent Network to explore opportunities.

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