Sr. Claims Specialist, Medical Malpractice | Long Term Care | California

PRIMARY PURPOSE OF THE ROLE

To analyze complex or technically difficult medical malpractice claims; to provide resolution of highly complex nature and/or severe injury claims; to coordinate case management within Company standards, industry best practices and specific client service requirements; and to manage the total claim costs while providing high levels of customer service.

ESSENTIAL RESPONSIBILITIES

• Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim;
• manages claims through well-developed action plans to an appropriate and timely resolution;
• conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions;
• calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life;
• recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement;
• coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines;
• uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients;
• identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost;
• represents Company in depositions, mediations, and trial monitoring as needed;
• communicates claim activity and processing with the client; maintains professional client relationships;
• ensures claim files are properly documented and claims coding is correct;
• refers cases as appropriate to supervisor and management;
• performs other duties as assigned;
• supports the organization's quality program(s).

Qualifications

• Education & Licensing: 6 years of claims management experience or equivalent combination of education and experience required. Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred.

Pay & Benefits

The range of starting pay for this role is $100,000 to $120,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.