Medical Malpractice Claims Specialist

Job Title – Medical Malpractice Claims Specialist

Location – Orange, California 92868

Starting Salary – $110,000 – $130,000

JOB# – GUSCAPHY

Industry: Insurance / Medical Professional Liability

Job Category: Claims / Risk Management

Position Overview:

The Medical Malpractice Claims Specialist is responsible for managing assigned medical malpractice claim files, including complex and high exposure matters. This role oversees claim investigation, litigation coordination, reporting, and documentation while working closely with defense counsel and internal stakeholders. The position also supports the development and oversight of junior Claims Specialists to ensure consistent adherence to claims handling standards and guidelines.

Key Responsibilities:

Manage assigned medical malpractice claims from intake through resolution
Handle complex and high exposure cases with increasing levels of responsibility
Oversee and coordinate defense counsel in accordance with the Claims Technical Manual, Defense Attorney Guidelines, and applicable agreements
Investigate claims including reviewing medical records, interviewing members, and corresponding with plaintiff attorneys
Coordinate expert evaluations and obtain preliminary opinions as needed
Prepare case evaluation reports for CRC, CSC, and discretionary authority review
Manage discovery, mediation, negotiation, and litigation activity under supervision as required
Monitor arbitrations and litigation progress and provide regular status updates
Maintain accurate claims documentation, coding, and chronological records
Timely update claims databases and index documents within the OnBase system

Qualifications:

Education:
Bachelors degree from a four year college or university required

Relevant Background:
Legal and or medical education background or equivalent professional experience

Claims Experience Knowledge:
Five years of medical malpractice claims management experience or
Three years of progressive claims handling experience

How to Apply:

Submit resume, JD transcripts, and clearance to PK Daigo, Managing Director and Global Strategist at KI Executive Group.
Email pkdaigo@kiexgroup.com or WhatsApp +1 670 286 3010.

Orange, California, United States