CAP seeks a Senior Claims Specialist, with medical malpractice experience, based in either Southern or Northern California, to perform technical and administrative duties to manage assigned claim files; assumes increased workload of highly complex claims. Participates in the continued training and supervision of Claims Specialist I and II’s.
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 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 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 project.
• Identify, investigate and follow-up on coverage issues.
• Take Hotline calls as requested and as necessary and prepare hotlines.
• Attend staff and department meetings as indicated.
• Assist management in training of Claims Specialist I and II’s.
• Employee education and awareness is an important element in the company’s cybersecurity program. Accordingly, the Senior Claims Specialist is responsible for being cautious and vigilant when opening emails, attachments, links, etc. on CAP’s computer equipment or when accessing the company system remotely. It is also the Senior Claims Specialist’s responsibility to complete cybersecurity training modules that are periodically distributed by CAP’s IT department.
• 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

Job Type: Full-time

Pay: $90,000.00 - $130,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

COVID-19 considerations:
CAP complies with all CDPH guidelines.

Ability to commute/relocate:

• Orange, CA 92868: Reliably commute or planning to relocate before starting work (Required)

Work Location: Hybrid remote in Los Angeles, CA 90071

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