Claims Specialist II, Medical Malpractice Claims
Overview
Own a portfolio of medical malpractice claims, managing 3+ years of complex cases with significant financial exposure. Oversee defense counsel, direct litigation strategy, and ensure compliance with company standards. Work within a collaborative team of claims professionals at CAP, supporting and training junior specialists. This role offers direct involvement in high-stakes mediations and trials, with clear pathways for advancement to senior specialist.
What You'll Do10
- 1Manage medical malpractice claims from inception to resolution, directing defense counsel and controlling litigation costs
- 2Investigate claims by interviewing members, reviewing medical records, and corresponding with plaintiff attorneys
- 3Obtain and evaluate expert opinions to build case strategy and assess exposure
- 4Present case evaluations to the CRC and CSC committees for approval and settlement authority
- 5Prepare settlement recommendations and negotiate resolutions within delegated authority
- 6Monitor trials and arbitrations, providing daily progress updates to stakeholders
- 7Document all case developments in the claims database and maintain accurate chronology entries
- 8Code claim files and ensure timely indexing of documents in OnBase
- 9Identify and investigate coverage issues, escalating as needed
- 10Train and mentor Claims Specialist I staff, sharing best practices and ensuring quality
Requirements7
- 13+ years of medical malpractice claims management experience or 1 year with CAP
- 2Bachelor's degree from an accredited college or university
- 3Valid California driver's license
- 4Demonstrated written and verbal communication skills
- 5Effective time management and ability to handle multiple priorities
- 6Proficiency with personal computers and claims management software
- 7Strong analytical skills for evaluating complex legal and medical issues
Salary Insight
Salary not disclosed in listing
Location
Required Skills
Similar open positions
Explore active roles that match your skills and interests.
Liberty Mutual
VerifiedSenior Claims Specialist, Commercial Property & Casualty
As a Senior Claims Specialist, you own a portfolio of moderately complex to complex commercial property and casualty claims, making decisions on liability and compensability, evaluating losses, and negotiating settlements. You operate within a Claims Team using latest technology, and you also mentor junior team members, assist with assigning claims, and provide technical direction. Your work directly impacts client outcomes and company profitability. This hybrid role requires in-office presence 2 days per month if within 50 miles of select offices.
CFC
VerifiedClaims Specialist - Healthcare & Life Sciences
You will own US healthcare, professional indemnity, and life sciences claims from first notification to settlement at CFC. You will analyze coverage, liability, and quantum while managing key legal deadlines and demand letters. You will build strong relationships with policyholders, brokers, and underwriters, delivering exceptional service. You will work closely with Claims, Underwriting, and Finance teams to support product development. This role offers the chance to obtain US state claims adjuster licenses and shape claims best practices.
Sedgwick
VerifiedClaims Team Lead - Workers Compensation (California)
You will own the daily operations of a California workers' compensation claims team at Sedgwick, a global leader in claims management. Your team of 6+ examiners and support staff handles complex, high-exposure claims across multiple jurisdictions. You will drive quality, compliance, and performance while developing your team's technical skills. This role offers direct client interaction and strategic influence on process improvement, all within a supportive and flexible hybrid work environment.
7 Cs Building Maintenance
VerifiedWorkers Compensation Claims Manager Phoenix AZ
The Workers' Compensation Claims Manager leads claims portfolio across multiple states focusing on California. This role supports internal risk management and financial oversight while advocating for the company. The manager ensures carriers and TPAs handle claims fairly and efficiently. They serve as the primary company representative in all WC matters helping the CFO make informed decisions about reserves settlements and risk management.
CorVel Enterprise Claims, Inc.
VerifiedSenior Liability Claims Specialist, Auto & General Liability
You will own mid to complex Auto and General Liability claims, including bodily injury and property damage, for a national risk management provider. You will manage litigated files with delegated authority, confirming coverage, determining compensability, and setting reserves. Your work directly impacts optimal outcomes for clients and CorVel. This remote role offers the chance to collaborate with a supportive team and leverage your expertise in a stable, growing company.
HICIX Hiscox Insurance Company Inc.
VerifiedComplex Claims Specialist-MPL HICIX
Lead handling of mid to high-severity professional liability claims from inception to resolution. Own the full claims lifecycle for diverse client groups. Drive defense strategy and mentor team members. Shape coverage and litigation processes. Stand out in a fast-paced environment.