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.

 

 

·         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).

 

 

·         Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred.

 

EXPERIENCE:

 

·         Seven (7) years of claims management experience or equivalent combination of education and experience required.

 

 

·         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

 

Best,

Kushal Shah

APN Software Service INC