Senior Claims Specialist - Medical Malpractice (California)

About the role

Sedgwick is hiring a Senior Claims Specialist for its Professional Liability and Medical Malpractice line in California. The role analyzes complex or technically difficult medical malpractice claims, resolves highly complex and severe-injury claims, coordinates case management within company standards and client requirements, and manages total claim costs while delivering high-quality customer service.

Key responsibilities

• Analyze and process complex medical malpractice claims by investigating and gathering information to determine exposure, then manage them through action plans to timely resolution.
• Conduct or assign full investigations and write reports on new events, claims and legal actions.
• Calculate and assign reserves, monitor their adequacy throughout the claim life, and recommend settlement strategies and structured settlement proposals.
• Coordinate legal defense by assigning attorneys, supporting investigations and reviewing attorney invoices; monitor counsel against client guidelines.
• Use cost-containment techniques such as strategic vendor partnerships, and investigate fraud, subrogation, contribution and recovery opportunities.
• Represent the company in depositions, mediations and trial monitoring as needed, and communicate claim activity to clients.
• Keep claim files properly documented with correct coding, refer cases to supervisors and management when appropriate, support quality programs and perform other assigned duties.

Required profile

• 6 years of claims management experience, or an equivalent combination of education and experience.
• Bachelor's degree from an accredited college or university preferred.
• Licenses as required, and professional certification for the line of business preferred.
• Strong analytical and negotiation skills, sound judgment, and the ability to deliver timely, cost-effective resolutions.

Required skills

• Computer keyboarding.
• Hearing, vision and talking abilities.
• Clear conceptual thinking, excellent judgment and discretion, and the ability to meet deadlines.

What we offer

• Starting pay range of $100,000 to $125,000 for this California role.
• A comprehensive benefits package including medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, and flexible spending or health savings accounts.