PRIMARY PURPOSE: To handle complex or high exposure claim issues; to provide medical knowledge of the health care system and health care issues; to independently investigate, analyze and evaluate medical malpractice claims for self-insured and commercially insured clients; to provide information needed to clients as needed to determine liability issues and exposure; and to assist in identification of risk management issues to decrease liability exposure and associated legal costs.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Handles complex or high exposure claim issues; advises and leads Nurse Consultant - PL colleagues.
• Receives requests for investigation; reviews and develops action plans and investigates cases accordingly.
• Collects data from Company and clients to document and communicate results as appropriate.
• Prepares reports summarizing medical records and interviews; outlines issues related to summary reports; and provides analysis and recommendations for further claims handling.
• Interviews practitioners involved in medical malpractice claims at hospital facilities weekly as needed.
• Participates in follow-up review and investigation as directed and assists in discovery requests as needed.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization’s quality program(s).
• Travels as required.

QUALIFICATIONS

Education & Licensing
Bachelor’s degree from an accredited college or university preferred. RN license required. LNC (Legal Nurse Consultant) Certification or training preferred.

Experience
Five (5) years related clinical nursing experience and two (2) years nurse consultant experience required. General or Professional Liability investigation related experience preferred.

Skills & Knowledge

• Technical claims knowledge of medical malpractice claims procedures and practices
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Excellent interpersonal skills
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines

Physical: Computer keyboarding, travel as required

Auditory/Visual: Hearing, vision and talking

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.

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 $80,000-$88,000. 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.