Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It’s an opportunity to do something meaningful, each and every day. It’s having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive.
A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you’re someone who cares, there’s a place for you here. Join us and contribute to Sedgwick being a great place to work.
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.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.