Senior Claims Specialist - Medical Malpractice (New Jersey)

About the role

Sedgwick is hiring a Senior Claims Specialist to handle complex medical malpractice claims involving severe injury and high exposure. The specialist analyzes difficult claims, coordinates case management within company standards and client requirements, and manages total claim costs while delivering high-quality customer service. The role is listed as telecommuter based in Texas.

Key responsibilities

• Analyze and process complex medical malpractice claims by investigating and gathering information to determine exposure, and 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 for compliance with 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 $115,000 for this role.
• Benefits including medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, and flexible spending or health savings accounts.