Demo

Claims Specialist

Hyatttalentsolutions
Orange, CA Full Time
POSTED ON 12/24/2025
AVAILABLE BEFORE 2/24/2026
Here’s a clean, modern, and ATS-friendly rewrite that tightens the language while keeping all responsibilities intact and professional. This version works well for job boards, internal postings, or client submissions.Job Title: Senior Claims Specialist – Medical MalpracticeLocation: Orange County, CAJob SummaryOur client is seeking an experienced Senior Claims Specialist to support their Orange County office. This role is responsible for managing assigned medical malpractice claim files, including a higher volume of complex cases with significant financial exposure. The Senior Claims Specialist also provides guidance, training, and oversight to Claims Specialist I and II team members while ensuring compliance with internal policies and regulatory requirements.Key ResponsibilitiesManage medical malpractice claims in compliance with the Claims Technical Manual, Defense Attorney Guidelines, and MPT AgreementAssign, direct, and oversee defense counsel under appropriate supervisionInvestigate and evaluate claim files by interviewing members, reviewing medical records, coordinating with plaintiff attorneys, and obtaining preliminary expert evaluationsPrepare detailed case evaluation reports for presentation to the CRC and CSCDevelop case evaluations for discretionary authority on selected claimsManage and participate in litigation activities, including discovery planning, mediation, mandatory settlement conferences (MSC), and negotiations as neededMonitor trials and arbitrations, providing daily updates and supporting members and defense counselPrepare claim resolution documentation and maintain accurate claim file recordsUpdate claims databases, chronologies, coding, and index documents within the OnBase system in a timely mannerIdentify, investigate, and follow up on coverage issuesRespond to hotline calls and prepare hotline documentation as requiredAssist management with special projects and departmental initiativesSupport training and mentoring of Claims Specialist I and II staffAttend staff and departmental meetings as requiredPerform additional duties as assignedQualificationsBachelor’s degree from an accredited four-year college or universityLegal and/or medical education background or equivalent experienceMinimum of five (5) years of medical malpractice claims management experience or three (3) years of CAP claims experienceValid California driver’s license

Salary : $22

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