SENIOR CLAIMS SPECIALIST Full Time

Cooperative of American Physicians, Inc. (CAP) is seeking a Senior Claims Specialist for our Orange County office.  This role involves handling technical and administrative responsibilities related to managing assigned claim files and taking on a larger caseload of highly complex claims. The Senior Claims Specialist also plays an active role in the ongoing training and oversight of Claims Specialist I and II team members.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Manage medical malpractice claims, including the assignment, direction and control of defense counsel, under supervision and in compliance with the Claims Technical Manual, the Defense Attorney Guidelines, and MPT and/or CAPIC policies.  Manage increasingly complex cases with larger financial exposure.
• Investigate and evaluate claim files including complying with the standards of performance, interviewing members, reviewing medical records, corresponding with plaintiff attorneys, obtaining preliminary expert evaluation/opinions, and preparing interview summaries.
• Prepare case evaluation reports for publication and presentation to the Claim Review Committee and/or Claim Staff Committee.
• Prepare case evaluation reports for discretionary authority on selected cases
• Manage and participate in all litigation activity, including discovery plan, mediation, MSC, and negotiation under close supervision.
• Monitor trials and arbitrations including daily progress reports, providing member and defense attorney with support.
• Prepare claim file resolution documentation.
• Timely update the claims database.
• Document all important case developments under the chronology tab.
• Code the claims file and update as relevant information is available.
• Timely review and index documents to the On Base system.
• Provide assistance to management as indicated on special projects.
• Identify, investigate and follow-up on coverage issues..
• Attend staff and department meetings as indicated.
• Take Hotline calls as requested and as necessary.
• Assist management in training of Claims Specialist I and II’s.
• Perform other duties as necessary.

EDUCATION and/or EXPERIENCE:

• Bachelor’s degree from four-year college or university;
• Relevant legal and/or medical education background or the equivalent.
• Minimum five years of medical malpractice claims management experience and/or three years CAP claims experience.

CERTIFICATES, LICENSES, REGISTRATIONS:  Valid California driver license

OTHER SKILLS and ABILITIES:

• Excellent demonstrated verbal and written communication skills.
• Effective time management skills.
• Ability to manage multiple priorities/deadlines
• Personal computer literate preferred.
• Strong analytical skills

HYBRID position

Starting Salary: $110,000 – $130,000/year (Depending on Experience)

Send cover and resume to HR@CAPphysicians.com

Tagged as: case management, medical malpractice