MD
Senior Claims Specialist
Macpower Digital Assets Edge Private Limited
🇺🇸 United States
On-site
Senior
5 days ago
$110,000 – $130,000 / year
5 days ago
Key Responsibilities:
- Manage medical malpractice claims , including assigning and directing defense counsel, following Claims Technical Manual, Defense Attorney Guidelines, and MPT Agreement.
- Handle increasingly complex claims with significant financial exposure.
- Investigate claim files by interviewing members, reviewing medical records, and corresponding with plaintiff attorneys.
- Obtain preliminary expert evaluations and prepare detailed interview summaries.
- Prepare case evaluation reports for review boards and discretionary authority.
- Manage litigation activities including discovery planning, mediation, mandatory settlement conferences, and negotiation under supervision.
- Monitor trials and arbitrations, provide daily progress reports, and support members and defense attorneys.
- Prepare claim resolution documentation and timely update claims databases.
- Document all case developments under chronology and update file coding with new information.
- Review and index documents into the OnBase system promptly.
- Assist management with special projects and training of Claims Specialist I and II team members.
- Identify, investigate, and follow up on coverage issues.
- Take and prepare Hotline calls as needed.
- Attend staff and department meetings as required.
- Perform other duties as assigned.
- Bachelor's degree from an accredited college or university.
- Relevant legal or medical education background or equivalent experience.
- Minimum 5 years' medical malpractice claims management experience or 3 years' CAP claims experience.
- Valid California driver's license required.
Senior Claims Specialist · Macpower Digital Assets Edge Private Limited