Medical Malpractice Claims Specialist

3 weeks ago

West, United States The Jacobson Group Full time
Job Summary

We are seeking a highly skilled Claims Specialist to manage complex medical malpractice claims, including the assignment, direction, and control of defense counsel, in compliance with the Claims Technical Manual, Defense Attorney Guidelines, and the MPT Agreement.

Key Responsibilities
  • Manage medical malpractice claims, including the assignment, direction, and control of defense counsel.
  • Oversee 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 close supervision.
  • Monitor trials and arbitrations, including daily progress reports, and provide support to members and defense attorneys.
  • Prepare claim file resolution documentation.
  • Update the claims database in a timely manner.
  • Document all important case developments under the chronology tab.
  • Review and index documents to the On Base system in a timely manner.
  • Provide assistance to management as indicated on special projects.
  • Identify and investigate coverage issues.
  • Take hotline calls as requested and as necessary.
  • Attend staff and department meetings as indicated.
Requirements
  • Bachelor's degree from four-year college or university.
  • Relevant legal and/or medical education background or the equivalent.
  • 3+ years of medical malpractice claims management experience and/or one year CAP claims experience.
  • Excellent verbal and written communication skills.
  • Effective time management skills.
  • Ability to manage multiple priorities and deadlines.
  • Personal computer literate (preferred).
  • Strong analytical skills.

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