Senior Claims Specialist, Professional Liability, Medical Malpractice

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

📋 Description

• Evaluate and process intricate or technically challenging medical malpractice claims

• Investigate and collect data to determine the exposure of claims

• Oversee claims through action plans to achieve timely resolutions

• Conduct or delegate comprehensive investigations and provide detailed investigation reports

• Calculate and allocate reserves while monitoring their adequacy

• Suggest settlement strategies and present structured settlement proposals

• Coordinate legal defense, assign attorneys, assist with investigations, and review attorney bills

• Ensure compliance of counsel with client guidelines

• Implement cost containment strategies and leverage strategic vendor partnerships

• Identify and investigate opportunities related to fraud, subrogation, contribution, recovery, and case management

• Represent the organization during depositions, mediations, and trial monitoring as required

• Update clients on claim activities and processing

• Foster and maintain professional relationships with clients

• Ensure accurate documentation of claim files and correct claims coding

• Escalate cases to supervisors and management when necessary

• Support the organization's quality assurance programs

• Perform additional duties as assigned

⛳️ Requirements

• A minimum of 6 years of claims management experience or an equivalent combination of education and experience is required

• A Bachelor’s degree from an accredited college or university is preferred

• Required licenses as applicable

• Professional certification relevant to the line of business is preferred

• Experience in managing complex medical malpractice claims involving severe injuries and high exposure

• Strong analytical and negotiation abilities

• Demonstrated sound judgment

• Capacity to deliver timely and cost-effective claim resolutions

• Ability to maintain a high standard of customer service

• Proficient in computer keyboarding

• Capable of hearing, vision, and verbal communication

• Possess clear and conceptual thinking skills

• Excellent judgment and discretion

• Ability to meet deadlines effectively

🏝️ Benefits

• Medical insurance

• Dental insurance

• Vision insurance

• 401(k) plan with matching contributions

• Paid time off (PTO)

• Disability insurance

• Life insurance

• Employee assistance programs

• Flexible spending or health savings accounts

• Additional voluntary benefits

• Support for work-life balance

• Equal opportunity workplace

• Drug-free workplace