Senior Claims Specialist, Medical Malpractice

This is a fully remote position, open to applicants in California.

📋 Description

• Evaluates and processes intricate or technically challenging medical malpractice claims by investigating and collecting information to assess the claim's exposure;

• Oversees claims through meticulously crafted action plans to achieve a suitable and timely resolution.

• Conducts or delegates comprehensive investigations and delivers reports concerning new incidents, claims, and legal actions.

• Computes and allocates timely and appropriate reserves for claims; monitors reserve sufficiency throughout the claim's duration.

• Suggests settlement strategies; presents structured settlement proposals as needed to optimize settlement outcomes.

• Coordinates legal defense by assigning attorneys, organizing investigation support, and reviewing attorney invoices; oversees compliance of counsel with client guidelines.

• Employs effective cost containment strategies, including strategic vendor partnerships, to minimize overall claims costs for our clients.

• Identifies and investigates potential fraud, subrogation, contribution, recovery, and case management opportunities to lower total claim expenses.

• Represents the Company in depositions, mediations, and trial monitoring as required.

• Communicates claim activities and processing updates to clients; maintains professional relationships with clients.

• Ensures claim files are accurately documented and that claims coding is correct.

• Refers cases to supervisors and management as appropriate.

• Performs additional duties as assigned.

• Supports the organization's quality program(s).

⛳️ Requirements

• A minimum of 6 years of claims management experience or a comparable combination of education and experience is required.

• A bachelor's degree from an accredited college or university is preferred.

• Licenses as required.

• Professional certification relevant to the line of business is preferred.

🏝️ Benefits

• Medical

• Dental

• Vision

• 401k and matching

• PTO

• Disability and life insurance

• Employee assistance

• Flexible spending or health savings account

• Other additional voluntary benefits