Careers at CAP

CAP is seeking a Claims Specialist for our Orange County office. This role involves handling technical and administrative responsibilities related to managing assigned claim files and taking on a larger caseload of highly complex claims. The Senior Claims Specialist also plays an active role in the ongoing training and oversight of Claims Specialist I and II team members.

Essential Duties and Responsibilities:

• Manage medical malpractice claims, including the assignment, direction, and control of defense counsel, under supervision and in compliance with the Claims Technical Manual, the Defense Attorney Guidelines, and the MPT Agreement.  Manage increasingly complex cases with larger financial exposure.

• 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 supervision, as necessary.

• Monitor trials and arbitrations including daily progress reports, providing member and defense attorney with support.

• Prepare claim file resolution documentation.

• Timely update the claims database.

• Document all important case developments under the chronology tab.

• Code the claims file and update as relevant information is available. 

• Timely review and index documents to the On Base system.

• Provide assistance to management as indicated on special project.

• Identify, investigate and follow-up on coverage issues.

• Take Hotline calls as requested and as necessary and prepare hotlines.

• Attend staff and department meetings as indicated.

• Assist management in training of Claims Specialist I and II’s.

• Perform other duties as necessary.

Education and/or Experience: 

• Bachelor’s degree from four-year college or university.
• Relevant legal and/or medical education background or the equivalent.
• Minimum five years of medical malpractice claims management experience and/or three years CAP claims experience.

Certificates, Licenses, Registrations:

• Valid California driver license                                                 

Other Skills and Abilities: 

• Excellent demonstrated verbal and written communication skills.
• Effective time management skills.
• Ability to manage multiple priorities/deadlines
• Personal computer literate preferred.
• Strong analytical skills

Starting Salary: $110,000 - $130,000/year (Depending on Experience)

Send cover and resume to HR@CAPphysicians.com

Know anyone interested in this position? Refer them to capphysicians.com/about-us/our-company/careers#claims-specialist.

Schmid & Voiles, the dedicated law firm for the Cooperative of American Physicians, Inc. seeks a Legal Secretary to perform diverse secretarial duties in support of the Legal Department, in San Diego.

Essential Duties and Responsibilities:

• Maintain attorney(s) calendar book and tickler system
• Schedule meetings with clients, experts, attorneys and co-counsel and schedule court appearances
• Review and re-index mail in OnBase for review and action by attorney and calendaring of same
• Compose correspondence and memos to request or provide information
• Contact clients to obtain desired information as requested by attorneys
• Maintain electronic confidential legal files and ensure that each file is organized and documented regarding activity
• Prepare discovery, pre-trial and trial documents for filing with court
• Schedule, calendars and coordinate all aspects of discovery initiated by plaintiff(s) and defendant(s)
• Provide legal secretarial support on either short- or long-term assignments
• Answer and screen telephone calls
• Winscribe/Transcribe dictation and/or type from handwritten material or rough draft copy, including correspondence relating to litigation (pleadings, court forms, reports, summaries, releases, etc.)
• Assist and provide back up for other secretaries
• Maintain current knowledge of court rules
• Perform additional tasks
• Participate in department and company projects

General Office Administration

• Answer and screen telephone calls; direct visitors
• Retrieve, post, and deposit all the daily mail; replenish and maintain sufficient postage for the office
• Maintain office supplies and order supplies as necessary
• Act as liaison with Office of the Building, Office Services, and IT for all facilities related issues; troubleshoot with IT and assist with resetting IT servers.
• Participate in department and company projects as requested
• Assist and provide back up for other secretaries as requested
• Perform additional duties as requested 

Education and/or Experience:

• High school diploma or GED
• 4-7 years of defense trial, litigation experience in a similar industry
• 3 years recent California Civil litigation experience
• Trial preparation experience

Other Skills and Abilities:

• Good organization and communication skills
• Thorough knowledge of court procedures
• Strong initiative and ability to work independently
• Computer literate –proficient in MS Word; knowledge of case management software; type 70+ wpm

Salary Range: $75,000 - $90,000/year

Send cover letter and resume to HR@CAPphysicians.com

Know anyone interested in this position? Refer them to capphysicians.com/about-us/our-company/careers#legal-secretary-iii-admin-assistant.

Under the direction of the Vice President, Risk Management & Patient Safety (RMPS), the RMPS Data Analyst reviews and analyzes medical professional liability (MPL) cases to identify root causes, contributing factors, patterns, and trends. Reviews medical records and legal documents using proprietary coding taxonomy. Creates concise and comprehensive clinical narratives; creates and presents analytical reports; supports Peer Review committees; researches risk management and professional liability topics and actively participates in developing CAP educational activities, physician resources and coverage determination guidelines. 

Essential Duties and Responsibilities:

• Identify individual cases to be analyzed based on purpose and type of report requested.
• Review and synthesize claim files and develop a chronological summary of clinically relevant information.
• Code all eligible claims for MPL-DSP (data sharing program) submission using designated coding taxonomy, applying clinical judgment and consistent methodology in assigning codes.
• Understand and assign specific contributing factors associated with the error and harm including clinical judgment issues, insufficient communication and supervision, inadequate technical skill and any other clinical issues which may have contributed to the allegation, injury, or the initiation of a claim.
• Enter case summaries and code into MPL-DSP database(s), ensuring data accuracy, completeness, timeliness, and consistency.
• Work closely with MPL-DSP vendor staff to insure inter-rater reliability of coded data by CAP staff.
• Coordinate MPL-DSP with external partner, including scheduling meetings (internal and external), data    transfer, and taxonomy training for CAP staff.
• Work closely with Underwriting, Information Services, and other departments to evaluate claims data, code case elements, and map data to perform analysis. Identify and communicate coding and documentation opportunities and deficiencies to claims managers and other staff as appropriate.
• Collaborate with Underwriting Data Analyst to develop summary (template) reports in MPL-DSP databases.
• Create, review, and produce claims data and analytical reports in multiple formats, including risk mitigation strategies from multiple related databases for RMPS projects and initiatives. Participate in meetings to present analytical reports to CAP departments, committees, physicians, and medical groups as assigned.
• Research risk management and professional liability topics and participate in developing CAP educational activities, articles, physician resources and coverage determination guidelines as requested.
• Work closely with Program Manager, Risk Assessment & Peer Review  (“RAPR”) to coordinate review of cases. Participate in RAPR meetings, including reviewing materials, drafting case summaries and minutes.
• Perform other duties as directed.

Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Education and Experience: 

• Bachelor’s degree in a healthcare related field preferred
• RN, MD, PharmD or clinical license preferred
• 3 years’ experience in healthcare risk management, claims, research, data analysis or equivalent experience in a healthcare related environment
• Computer literate, proficient in Microsoft Word, Excel, Outlook, and PowerPoint .
• Proficiency in Microsoft Access and Power BI, Salesforce, and OnBase software preferred

• 2 years’ experience extracting and analyzing data from a relational database       

• Professional liability experience is highly preferred

• Coding experience, including ICD-10 desired

• Experience identifying educational and learning needs/gaps of healthcare professionals or physician office practices and recommending risk mitigation strategies highly preferred

• Experience writing articles, healthcare educational material, and professional business correspondence preferred

Other Skills and Abilities:

• Fluent in medical terminology
• Excellent verbal and written communication skills
• Excellent customer service skills
• Ability to work independently and collaboratively 

• Detail-oriented and have good organizational and time management skills

• Knowledge of root cause analysis (RCA) and adverse event management

• Knowledge of statistical concepts and experience using statistical platforms for analyzing datasets 

• Strong analytical skills with the ability to collect, organize, analyze, and disseminate information with attention to detail and accuracy

• Adept at writing detailed reports and presenting findings

• Adept at database queries and code generation/interpretation

• Ability to travel to practice locations, meetings, or conferences within California, and occasionally nation-wide, with overnight stays, when requested

Preferred Knowledge of the Following:

California and federal laws and regulations pertaining to the practice of medicine and healthcare, including MICRA; medical risk management techniques; professional liability coverage; hospital and medical office policies and procedures; social behavioral and educational research techniques and evaluation; and medical, legal, insurance databases.

SALARY: $84,000 - $120,000/year (Depending on Experience)

Send cover letter and resume to HR@CAPphysicians.com

Know anyone interested in this position? Refer them to capphysicians.com/about-us/our-company/careers#rmps-data-analyst.