Senior Claims Specialist
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Job Location:
Orange, CA - USA
Monthly Salary:
Not Disclosed
Posted on:
2 hours ago
Vacancies:
1 Vacancy
Job Summary
Location: Orange CA 92859 (Onsite)
Employment Type: Contract / Contract-to-Hire (Based on Performance)
Schedule: Full-Time Position Overview
We are seeking an experienced Senior Claims Specialist to manage high-exposure and complex medical malpractice claims. This role involves full lifecycle claim handling litigation coordination case evaluation and mentoring junior claims professionals.
The ideal candidate will bring strong analytical expertise litigation management experience and the ability to handle multiple high-level claims simultaneously.
Key Responsibilities-
Manage medical malpractice claims including high complexity and large financial exposure cases
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Assign direct and coordinate with defense counsel in compliance with internal claims guidelines
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Investigate and evaluate claims by:
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Reviewing medical records
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Interviewing involved parties
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Communicating with plaintiff attorneys
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Securing expert evaluations/opinions
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Prepare detailed case evaluation reports for review committees
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Participate in litigation activities including:
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Discovery planning
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Mediation
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Mandatory Settlement Conferences (MSC)
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Negotiations
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Monitor trials and arbitrations; provide daily progress updates
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Maintain accurate claims documentation and database updates
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Code and document key case developments in claims systems
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Review and index documents in document management systems (OnBase or similar)
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Identify and address coverage-related issues
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Respond to hotline calls and prepare hotline reports
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Assist in training and mentoring Claims Specialist I & II team members
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Support management with special projects as needed
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Bachelors degree required (Legal or Medical background preferred)
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Minimum 5 years of medical malpractice claims management experience
OR -
3 years of CAP claims experience
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Strong experience managing litigation and high-value claims
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Valid California Drivers License required
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Excellent written and verbal communication skills
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Strong analytical and investigative abilities
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Effective time management and ability to meet deadlines
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Ability to manage multiple high-priority claims simultaneously
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Proficiency with claims management systems and Microsoft Office
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Strong documentation and reporting skills
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Experience working in structured claims environments
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Familiarity with Claims Technical Manuals & Defense Attorney Guidelines
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Experience mentoring or training junior staff
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Work on complex high-impact medical malpractice cases
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Opportunity to mentor and lead within claims operations
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Stable and professional work environment
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Potential for long-term engagement
.
Key Skills
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