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

Risk Claims Manager

RiskRiskFull TimeRemoteTeam 10,001+H1B SponsorCompany Site LinkedIn

Location

Texas

Posted

131 days ago

Salary

Not specified

Postgraduate Degree10 yrs expExperience acceptedEnglish

Job Description

• Analyzes and processes complex or technically difficult liability 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. • Negotiates claim settlement up to designated authority level. • 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. • Performs coverage analysis and opinion as part of the claim process including all necessary correspondence. • 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. • Delegates work and mentors others.

Job Requirements

Masters or Juris Doctorate degree from an accredited college or university preferred.
Licenses as required.
Designations and/or licensing including but not limited to Bachelor of Science in Nursing, Legal Nurse Consultant, Associate in Claims (AIC), Chartered Property and Casualty Underwriter (CPCU), Associate in Risk Management (ARM), Associate in Insurance Claims (AIC), Certified Professional in Health Care Risk Management (CPHRM) preferred.
Ten (10) years of complex claims management experience or equivalent combination of education and experience required.
In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business
Extensive knowledge and comprehension of insurance coverage
Claims expertise in medical malpractice, errors and omissions, directors and officers, life sciences, and/or cyber liability
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Excellent negotiation skills

Benefits

Health insurance
401(k) matching
Flexible work hours
Paid time off
Remote work options

Related Categories

Risk

Related Job Pages

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Full TimeRemoteTeam 1,001-5,000H1B No Sponsor

Company Site LinkedIn

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