高级索赔专员，专业责任 | 医疗疏忽 | 长期护理
Sr. Claims Specialist, Professional Liability | Medical Malpractice | Long Term
加入Sedgwick，你将参与真正有意义的工作。我们的33,000名同事每天为全球面临意外的人们提供帮助。我们邀请你与我们共同成长，体验我们的关怀文化，并享受工作与生活的平衡。在这里，你所能实现的没有界限。
Newsweek 将 Sedgwick 评为美国最佳职场之一
被认证为“最佳工作场所®”
财富杂志金融与保险行业最佳工作场所
高级理赔专员，专业责任 | 医疗疏失 | 长期护理
职位主要职责：分析复杂的或技术性较强的医疗疏失理赔，包括长期护理设施；解决高度复杂或严重伤害的理赔；在公司标准、行业最佳实践和特定客户要求范围内协调案件管理；同时控制整体理赔成本并提供高水平的客户服务。
你是否是理想的候选人？
我们正在寻找有经验的专业人士来处理涉及严重伤害和高风险的医疗疏失理赔。理想的候选人应具备强大的分析和谈判能力，能够做出合理的判断，并致力于及时、经济有效地解决理赔，同时保持高水平的客户服务。
主要职责可能包括：
- 通过调查和收集信息分析和处理复杂的或技术性较强的医疗疏失理赔，以确定理赔的风险；通过制定完善的行动计划，将理赔妥善且及时地解决。
- 进行或指派全面调查，并就新事件、理赔和法律行动提供调查报告。
- 及时合理地计算并分配理赔准备金；在整个理赔生命周期中监控准备金的充足性。
- 建议和解策略；在必要时提出结构化和解方案以最大化和解效果。
- 协调法律辩护，包括指派律师、支持调查并审查律师发票；监督律师是否符合客户指南。
- 使用适当的成本控制技术，包括战略性供应商合作，以降低客户的整体理赔成本。
- 识别并调查可能的欺诈、代位追偿、分摊、追偿和案件管理机会，以减少总损失。
查看英文原文
By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Sr. Claims Specialist, Professional Liability | Medical Malpractice | Long Term Care
PRIMARY PURPOSE OF THE ROLE: To analyze complex or technically difficult medical malpractice claims including long term care facilities; 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.
ARE YOU AN IDEAL CANDIDATE?
We are seeking experienced professionals to manage complex medical malpractice claims involving severe injury and high exposure. Ideal candidates demonstrate strong analytical and negotiation skills, exercise sound judgment, and are committed to delivering timely, cost‑effective claim resolutions while maintaining a high level of customer service.
ESSENTIAL RESPONSIBLITIES MAY INCLUDE:
- 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.
- 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.
- Performs other duties as assigned.
- Supports the organization's quality program(s).
QUALIFICATIONS
Education & Licensing: 6 years of claims management experience or equivalent combination of education and experience required.
- Bachelor's degree from an accredited college or university preferred. Licenses as required.
- Professional certification as applicable to line of business preferred.
Work environment requirements include –
Physical: Computer keyboarding
Auditory/visual: Hearing, vision and talking
Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $100,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
Originally posted on Himalayas