Senior Claims Specialist (Orange County) #25-01680

Job Summary: Seeking a Senior Claims Specialist to manage a complex caseload of medical malpractice claims, supervise junior claims specialists, and contribute to ongoing training efforts.

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 and Experience:

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.

Licenses and Certifications:

Valid California driver's license required.

Skills and Abilities:

Excellent verbal and written communication skills.

Effective time management and organizational skills.

Ability to manage multiple priorities and deadlines.

Proficient with personal computers preferred.

Strong analytical abilities.