Claim Specialist II / Sr. Claims Specialist

CAP seeks a Claims Specialist II or Senior Claims Specialist. This role involves handling technical and administrative duties to manage assigned claim files, as well as participates in the ongoing training and oversight of Claims Specialist I team members. 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. Review all bills for reasonableness. 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. Time Provide assistance to management as indicated on special project. Identify, investigate and follow-up on coverage issues. Timely review and index documents to the On Base system. 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 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 three years of medical malpractice claims management experience and/or one year CAP claims experience. CERTIFICATES, LICENSES, REGISTRATIONS: OTHER SKILLS and ABILITIES: Excellent demonstrated verbal and written communication skills. Ability to manage multiple priorities/deadlines Strong analytical skills Starting Salary : $110,000 - $130,000 annually (Depending on Experience) 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. #J-18808-Ljbffr Cooperative of American Physicians