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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
