Client: Sedgwick Claims Management Services, Inc.
Title: Sr. Claims Specialist – Medical Malpractice
Req #: 526805
Location: 290-300 Broadhollow Road, Suite 215W Melville NY 11747-4801
Duration: Direct Hire
Shift Hours: 7.5 hrs per day, 5 days/week
Claims Line of Business: PL – Professional Liability
Sr. Claims Specialist – Medical Malpractice
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).
EDUCATION & LICENSING:
· Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred.
· Seven (7) 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
APN Software Service INC