Senior Claims Specialist

Job Summary

Key Responsibilities

• Manage medical malpractice claims, including assigning and directing defense counsel, following Claims Technical Manual, Defense Attorney Guidelines, and MPT Agreement.
• Handle increasingly complex claims with significant financial exposure.
• Investigate claim files by interviewing members, reviewing medical records, and corresponding with plaintiff attorneys.
• Obtain preliminary expert evaluations and prepare detailed interview summaries.
• Prepare case evaluation reports for review boards and discretionary authority.
• Manage litigation activities including discovery planning, mediation, mandatory settlement conferences, and negotiation under supervision.
• Monitor trials and arbitrations, provide daily progress reports, and support members and defense attorneys.
• Prepare claim resolution documentation and timely update claims databases.
• Document all case developments under chronology and update file coding with new information.
• Review and index documents into the OnBase system promptly.
• Assist management with special projects and training of Claims Specialist I and II team members.
• Identify, investigate, and follow up on coverage issues.
• Take and prepare Hotline calls as needed.
• Attend staff and department meetings as required.
• Perform other duties as assigned.

Education, Experience, Licenses and Certifications

• Bachelor's degree from an accredited college or university.
• Relevant legal or medical education background or equivalent experience.
• Minimum 5 years' medical malpractice claims management experience or 3 years' CAP claims experience.
• Valid California driver's license required.