Claims Advisor, Professional Liability | Medical Malpractice

Job Title

Claims Advisor, Professional Liability | Medical Malpractice

Primary Purpose of the Role

Manage and handle medical malpractice and professional liability claims; provide resolution of highly complex nature and/or severe injury claims; coordinate case management within company standards, industry best practices and specific client service requirements; manage the total claim costs while providing high levels of customer service.

Essential Responsibilities

• Analyze and process complex or technically difficult liability claims by investigating and gathering information to determine the exposure on the claim; manage claims through well‑developed action plans to an appropriate and timely resolution.
• Conduct or assign full investigation and provide report of investigation pertaining to new events, claims and legal actions.
• Negotiate claim settlement up to designated authority level.
• Calculate and assign timely and appropriate reserves to claims; monitor reserve adequacy throughout claim life.
• Recommend settlement strategies; bring structured settlement proposals as necessary to maximize settlement.
• Perform coverage analysis and produce opinions as part of the claim process including all necessary correspondence.
• Coordinate legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitor counsel for compliance with client guidelines.
• Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for clients.
• Identify and investigate for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
• Represent company in depositions, mediations, and trial monitoring as needed.
• Communicate claim activity and processing with the client; maintain professional client relationships.
• Ensure claim files are properly documented and claims coding is correct.
• Refer cases as appropriate to supervisor and management.
• Delegate work and mentor others.

Qualifications

• Education & Licensing: Ten (10) years of complex claims management experience or equivalent combination of education and experience required.
• Masters or Juris Doctorate degree from an accredited college or university preferred.
• Licenses as required.
• Preferred designations and/or licensing: Bachelor of Science in Nursing, Legal Nurse Consultant, Associate in Claims (AIC), Chartered Property and Casualty Underwriter (CPCU), Associate in Risk Management (ARM), Associate in Insurance Claims (AIC), Certified Professional in Health Care Risk Management (CPHRM).

Skills

• 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.
• Extensive knowledge and comprehension of insurance coverage claims expertise in medical malpractice, errors and omissions, directors and officers, life sciences, and/or cyber liability.
• 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 Requirements

• Physical: Computer keyboarding.
• Auditory/visual: Hearing, vision and talking.
• Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.

Compensation and Benefits

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.

Equal Opportunity Employer

Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace.