Senior Claims Specialist, Medical Malpractice

Sedgwick

. Analyze and process complex or technically difficult medical malpractice claims .

Posted 11/12/2026full-timeRemote • United StatesSenior💰 $110,000 - $120,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing complex medical malpractice claims, including investigation, negotiation, and resolution strategies. Proficient in applying medical malpractice insurance principles, cost containment techniques, and maintaining professional client relationships.

Highest-signal resume keywords

Claims Management ExperienceMedical Malpractice Insurance KnowledgeNegotiation SkillsAnalytical SkillsCommunication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingInvestigation TechniquesSettlement StrategiesClaims CodingCost Containment PrinciplesMedical Management PracticesFraud InvestigationClaim Reserves CalculationSocial Security Application ProceduresPerformance Competencies

Soft Skills

Organizational SkillsInterpersonal SkillsTeam CollaborationMentoringPresentation Skills

Tools & Technologies

Microsoft Office

Certifications & Qualifications

Professional Certification

Industry Keywords

Medical Malpractice ClaimsLegal Defense CoordinationClaim SettlementsClient Guidelines ComplianceCredit Security Clearance

About the role

Key responsibilities & impact

Analyze and process complex or technically difficult medical malpractice claims
Investigate and gather information to determine claim exposure
Manage claims through action plans to timely and appropriate resolution
Conduct or assign investigations and provide investigation reports
Negotiate claim settlements up to designated authority level
Calculate, assign, and monitor claim reserves
Recommend settlement strategies and develop structured settlement proposals
Coordinate legal defense, assign attorneys, support investigations, and review attorney invoices
Monitor counsel compliance with client guidelines
Apply cost containment techniques and strategic vendor partnerships
Investigate potential fraud, subrogation, contribution, recovery, and case management opportunities
Represent the company in depositions, mediations, and trial monitoring as needed
Communicate claim activity and processing with clients
Maintain professional client relationships
Ensure claim files are documented and claims coding is correct
Refer cases to supervisors and management as appropriate
Delegate work and mentor assigned staff
Support the organization's quality programs
Perform other duties as assigned

Requirements

What you’ll need

Bachelor's degree from an accredited college or university preferred
Licenses as required
Professional certification as applicable to line of business preferred
Six (6) years of claims management experience or equivalent combination of education and experience required
In-depth knowledge of appropriate medical malpractice insurance principles and laws
Knowledge of recoveries, offsets and deductions, claim and disability duration, and cost containment principles
Knowledge of medical management practices and Social Security application procedures as applicable
Excellent oral and written communication, including presentation skills
PC literacy, 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
Credit security clearance confirmed via a background credit check is required

Benefits

Comp & perks

Medical insurance
Dental insurance
Vision insurance
401k and matching
PTO
Disability insurance
Life insurance
Employee assistance
Flexible spending or health savings account
Other additional voluntary benefits
Reasonable accommodations when applicable and appropriate