What are the responsibilities and job description for the Claims Specialist position at Cooperative of American Physicians, Inc.?
CAP seeks a Senior Claims Specialist, for its Orange County office, 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.
Our dedicated employees are the essential element to CAP’s success. CAP’s team of well-trained professionals with a commitment to excellence has helped deliver to our member physicians an unparalleled quality of products and services. Our corporate culture and collegial collaboration of minds and efforts is unmatched.
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.
Education and / or Experience :
