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Our client is seeking an experienced Claims Specialist to join their Orange County office. This role is responsible for managing a portfolio of highly complex medical malpractice claims while also supporting the development and oversight of junior claims staff. The ideal candidate brings strong analytical skills, litigation management experience, and the ability to handle sensitive matters with professionalism and sound judgment.

• Manage medical malpractice claims, including assignment, direction, and oversight of defense counsel in accordance with established guidelines and procedures
• Handle complex cases with significant financial exposure
• Investigate and evaluate claim files through member interviews, medical record reviews, communication with plaintiff attorneys, and preliminary expert evaluations
• Prepare detailed case evaluation reports for internal review committees and for discretionary authority on selected matters
• Participate in all phases of litigation including discovery planning, mediation, settlement conferences, and negotiation as needed
• Monitor trials and arbitrations, providing daily progress updates and support to involved parties
• Prepare claim resolution documentation and maintain accurate, timely updates within the claims database
• Document key case developments and ensure proper coding and indexing of files within internal systems
• Identify, investigate, and follow up on coverage issues
• Respond to hotline calls and prepare related documentation as needed
• Attend department meetings and assist management with special projects
• Support training and oversight of Claims Specialist I and II team members
• Perform additional duties as required

Qualifications

• Bachelor’s degree from an accredited four-year college or university
• Legal and/or medical background preferred or equivalent professional experience
• Minimum five years of medical malpractice claims management experience
• Valid California driver’s license

Skills and Abilities

• Strong analytical and organizational abilities
• Effective time management and ability to manage multiple priorities and deadlines
• Proficiency with computer systems and claims management software preferred
• Ability to work independently while collaborating with cross-functional teams

Compensation and Benefits:

• Salary Range: $110,000 – $130,000 annually (Depending on experience and qualifications)
• Comprehensive benefits package including medical, dental, vision, life, AD&D, LTD, 401(k) with employer match, PTO, separate sick time, and paid holidays

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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, marital status, national origin, age, veteran status, disability, or any other protected class.