Senior Medical Malpractice Claims Specialist

Join our team at Sedgwick, where we are committed to making a positive impact for individuals facing unexpected challenges. By being part of our team, you'll experience a culture that prioritizes care, work-life balance, and professional development. Explore a rewarding career with endless opportunities! Recognized by Newsweek as one of America’s Greatest Workplaces and certified as a Great Place to Work®, Sedgwick provides a supportive environment where you can thrive. PRIMARY PURPOSE: We are seeking a Senior Medical Malpractice Claims Specialist to expertly navigate complex malpractice claims, ensuring that severe injury cases are resolved efficiently while managing claim costs and providing outstanding customer service. ARE YOU THE RIGHT FIT? If you excel in collaboration and are driven to achieve exceptional results, we want to hear from you! ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Analyze and manage intricate medical malpractice claims, implementing detailed action plans for timely resolution. Conduct thorough investigations for new claims and legal actions, delivering comprehensive reports. Negotiate claim settlements within your authority limits to ensure optimal outcomes. Timely assess and assign reserves, ensuring they remain adequate throughout the claim process. Develop and recommend strategies to maximize settlement effectiveness. Coordinate legal defense, ensuring compliance with client guidelines and reviewing attorney invoices closely. Utilize cost containment techniques to lower overall client claim expenses. Investigate potential fraud and identify recovery opportunities. Represent the company in depositions, mediations, and trial monitoring as required. Maintain clear communication with clients regarding claim activity to foster professional relationships. Document claims accurately and handle coding efficiently. Delegate tasks and mentor junior staff members to enhance team performance. ADDITIONAL FUNCTIONS AND RESPONSIBILITIES: Perform other assigned duties as necessary. Contribute to the quality initiatives within the organization. QUALIFICATIONS: Education & Licensing: A bachelor’s degree from an accredited institution is preferred. Relevant licenses and professional certifications are beneficial. Experience: Six (6) years of experience in claims management or an equivalent combination of education and experience is required. Skills & Knowledge: In-depth knowledge of medical malpractice insurance principles and laws, including claims duration and cost containment methods. Exceptional oral and written communication skills, along with strong presentation abilities. Proficiency in Microsoft Office and relevant PC applications. Strong analytical and organizational skills, demonstrating attention to detail. Excellent negotiation and interpersonal skills for maintaining professional relationships. Ability to thrive in a collaborative, team-oriented environment. Capacity to meet and exceed performance competencies. WORK ENVIRONMENT: We value accessibility and will consider reasonable accommodations when necessary. TAKING CARE OF YOU: We offer a comprehensive benefits package that includes: Three choices for medical insurance and two dental plans. Eligibility for tuition reimbursement. A 401K plan with a 50% match on contributions up to the first 6% saved. Four weeks of Paid Time Off (PTO) in your first full year. NEXT STEPS: If you are selected to move forward in the process, a recruiter will contact you. Sedgwick shares a salary range for this position, accounting for skills and experience, typically between $100,000 and $110,000. A full benefits package, including medical, dental, vision, 401k matching, PTO, disability, life insurance, and additional voluntary benefits, is included. This document outlines the job's general nature and level of responsibilities and does not provide an exhaustive list of all tasks. Management retains the discretion to enhance or modify the role as necessary. Sedgwick is committed to equal opportunity and maintaining a drug-free workplace. If you are interested in this position but do not meet all the qualifications, we encourage you to apply regardless. Sedgwick values diversity and inclusion, recognizing that unique skills and experiences contribute to our workforce. Sedgwick stands as a leader in risk and claims administration, aiding clients in navigating unforeseen challenges with exceptional solutions in a dynamic risk environment.

Created: 2026-03-04