Sr. Claims Specialist, Professional Liability | Medical Malpractice (Long Term Care) | Florida
Job Overview
Location
Telecommuter FL
Job Type
Full-time
Category
HR & Recruiting
Date Posted
March 25, 2026
Full Job Description
📋 Description
- • As a Sr. Claims Specialist in Professional Liability focusing on Medical Malpractice (Long Term Care) at Sedgwick, you will play a critical role in resolving complex, high-stakes claims that directly impact healthcare providers and patients, ensuring fair outcomes while managing financial exposure and upholding the company’s commitment to service excellence.
- • You will analyze and process technically difficult medical malpractice claims by conducting thorough investigations, gathering evidence, and assessing exposure to develop action plans leading to timely and appropriate resolutions.
- • You will conduct or assign full investigations into new events, claims, and legal actions, producing detailed reports that inform decision-making and support litigation readiness.
- • You will negotiate claim settlements within your designated authority, applying strategic judgment to achieve fair outcomes while controlling costs.
- • You will calculate and assign accurate reserves, continuously monitoring their adequacy throughout the claim lifecycle to ensure financial accuracy and compliance.
- • You will recommend and implement settlement strategies, including structured settlements, to maximize resolution value and minimize long-term liability.
- • You will coordinate legal defense by assigning counsel, supporting investigative efforts, reviewing attorney invoices, and ensuring adherence to client guidelines and litigation budgets.
- • You will apply cost containment techniques through strategic vendor partnerships and medical management practices to reduce overall claim expenses for clients.
- • You will identify and pursue opportunities for fraud detection, subrogation, contribution, and recovery to further reduce total claim costs.
- • You will represent Sedgwick in depositions, mediations, and trial proceedings as needed, providing expert testimony and case oversight.
- • You will maintain clear, professional communication with clients, keeping them informed of claim activity and fostering strong, trust-based relationships.
- • You will ensure all claim files are meticulously documented and correctly coded according to company and industry standards.
- • You will mentor and delegate tasks to junior staff, supporting their development and contributing to team performance.
- • You will support Sedgwick’s quality initiatives and perform other duties as assigned, contributing to continuous improvement and organizational excellence.
- • You will join a purpose-driven organization of 33,000 colleagues recognized by Newsweek as one of America’s Greatest Workplaces, certified as a Great Place to Work®, and honored by Fortune as a Best Workplace in Financial Services & Insurance.
- • You will enjoy the flexibility of a telecommuter role based in Florida, enabling work-life balance while contributing to a national leader in claims management.
- • You will grow your expertise in professional liability and medical malpractice claims, deepening your knowledge of healthcare risk, legal processes, and cost containment strategies in a supportive, inclusive culture that values diverse backgrounds and experiences.
🎯 Requirements
- • Bachelor’s degree from an accredited college or university preferred, with professional certification in claims or insurance preferred.
- • Minimum of six (6) years of claims management experience, or an equivalent combination of education and experience.
- • In-depth knowledge of medical malpractice insurance principles, applicable laws, recoveries, offsets, disability duration, cost containment, medical management practices, and Social Security application procedures.
- • Excellent oral and written communication skills, including presentation abilities.
- • Proficiency in PC use and Microsoft Office products.
- • Strong analytical, interpretive, organizational, negotiation, and interpersonal skills.
- • Ability to work effectively in a team environment, manage multiple priorities, meet deadlines, and handle work-related stress with sound judgment and discretion.
🏖️ Benefits
- • Opportunity to work remotely (telecommuter) from Florida, supporting work-life balance.
- • Part of a nationally recognized employer: Newsweek’s America’s Greatest Workplaces, Great Place to Work® certified, and Fortune’s Best Workplaces in Financial Services & Insurance.
- • Access to a caring, inclusive culture that values diversity, equity, and inclusion, with encouragement to apply even if qualifications are not a perfect match.
- • Professional growth through mentoring responsibilities and exposure to complex, high-impact claims.
- • Support for continuous learning and development within a stable, purpose-driven organization serving people facing unexpected challenges.
Skills & Technologies
Senior
Onsite
Degree Required
About Sedgwick Claims Management Services, Inc.
Sedgwick is a global provider of technology-enabled risk, benefits and integrated business solutions, primarily handling insurance claims, managed care, absence and disability, and productivity management for employers, carriers, and administrators. The company processes millions of claims annually across workers' compensation, property, casualty, disability, and other lines, leveraging analytics and digital platforms to improve outcomes, reduce costs, and enhance customer and employee experiences.
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