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Job Details:
Seeking a 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.
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 the MPT Agreement. 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 CRC and CSC.
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 supervision, as necessary.
Monitor arbitrations including daily progress reports to 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.
Education and/or Experience:
Bachelor’s degree from four-year college or university.
Relevant legal and/or medical education background or the equivalent.
5 years of medical malpractice claims management experience or 3 years claims experience.
5 years of medical malpractice claims management experience or 3 years claims experience.