Overview
Remote
On Site
Depends on Experience
Full Time
10% Travel
Unable to Provide Sponsorship
Skills
Claims Management
CAP Claims
medical malpractice claims management experience
time management
computer literat
Job Details
Position: Senior Claims Specialist
Location: Orange County, CA (Onsite)
Job Type: Fulltime/W2
Job Type: Fulltime/W2
Role Summary:
This role is responsible for managing highly complex medical malpractice claims and handling both technical and administrative claim responsibilities. The Senior Claims Specialist will manage a larger caseload with increased financial exposure and will play a key role in training and mentoring Claims Specialist I and II team members.
Key Responsibilities:
- Manage medical malpractice claims, including assignment, direction, and oversight of defense counsel, in compliance with internal policies, Claims Technical Manual, Defense Attorney Guidelines, and the MPT Agreement
- Handle increasingly complex claims with higher financial exposure
- Investigate and evaluate claim files by interviewing members, reviewing medical records, corresponding with plaintiff attorneys, and obtaining expert evaluations
- Prepare detailed case evaluation reports for presentation to CRC and CSC committees
- Manage and participate in all litigation activities, including discovery planning, mediation, mandatory settlement conferences (MSC), and negotiations under supervision
- Monitor trials and arbitrations, provide daily progress reports, and support members and defense counsel
- Prepare claim resolution documentation and ensure accurate and timely updates to the claims database
- Maintain detailed claim chronologies and properly code claims files
- Review, index, and manage documents within the OnBase system
- Identify, investigate, and follow up on coverage-related issues
- Take hotline calls as required and prepare hotline documentation
- Participate in staff and department meetings
- Assist management with training and development of Claims Specialist I and II team members
- Support management with special projects and perform other duties as needed
Required Qualifications:
- Bachelor’s degree from an accredited four-year college or university
- Relevant legal and/or medical background, or equivalent experience
- Minimum 5 years of medical malpractice claims management experience or 3 years of CAP claims experience
- Strong analytical and problem-solving skills
- Excellent verbal and written communication skills
- Effective time management skills with the ability to manage multiple priorities and deadlines
- Computer literacy preferred
Licenses & Certifications:
- Valid California Driver License
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