Sr. Medical Malpractice Claims Specialist

PRISM is a joint powers authority (JPA) that provides risk management and insurance solutions for public entities throughout California. Our organization is member driven meaning that our public entity members have numerous opportunities available to participate in the governance of our JPA. Company Website Job Title Sr. Medical Malpractice Claims Specialist Job Description Location 75 Iron Point Cir Ste 200, Folsom, CA, 95630-8813, United States Base Pay $8,251.00 - $10,107.00 / Month Other Compensation Performance Incentive Pay Relocation Expense Covered No Employee Type Exempt Manage Others No Selected candidates will have the option to work full time in our Folsom office, or remotely from a home location within a commutable distance from our Folsom, CA office, or a hybrid of both options. Candidates must be able and willing to report in person to our Folsom location when required which is generally 2 to 3 times per month but could change based on business needs. The Sr. Medical Malpractice Specialist is responsible for managing a caseload of primary and excess medical malpractice claims, consisting of complex and catastrophic claims along with providing oversight of self-administered member claims handling or third party administrator (TPA) claims handling. In addition, the position will oversee claims processes in both our primary and excess medical malpractice programs; reviewing and overseeing claims for appropriate claim strategy, reserves, reimbursement, reinsurance and resolution. RESPONSIBILITIES Provide timely response to members and reinsurers within established goals. Effectively maintain current diary including file document updates, correspondence, and evaluation of strategies towards resolution or trial on a 150 - 200 pending claims caseload. Evaluate medical malpractice liability and damages for less complex to complex public entity excess files with supervisor oversight. Effectively manage litigation in partnership with member entities. Monitor and evaluate case strategy, litigation management, reserves and case status to ensure compliance with applicable Medical Malpractice Claims Handling Guidelines as well as Defense Counsel Standards. Work with members, TPAs and defense counsel to evaluate case strategy, damages, and future action needed with an eye towards settlement or trial. Analyze coverage for less complex to complex exposures and generate coverage related correspondence with supervisor oversight. Engage coverage counsel for complex coverage issues as needed. Ensure losses have been reported to reinsurers/excess carriers and update reinsurers/excess carriers on cases involving their layer. Complete case analysis and closed session write ups as well as present claims to the appropriate Committee(s) for settlement authority, direction and/or coverage determination. Effectively maintain files in the PRISM Proprietary Claims System, including strict compliance with documentation standards relating to exposure analysis, action plans, data compliance, reserves, reinsurer acknowledgements and status and other correspondence. Generate requisite reports for diary and litigation calendars. Contact member agencies, TPAs, defense counsel or reinsurers/excess carriers concerning claims status and information. Review and approve reimbursements and reinsurer invoicing for assigned claims. Create and maintain positive, collaborative relationships with members, committees, staff, reinsurers, and defense counsels. Actively participate in committee meetings as necessary. Attend mediations/MSCs as needed. Communicate regularly with Chief Claims Officer regarding claims activity and needed assistance. Maintain familiarity with JPA governing documents and policies. Participate in personal professional development, including legal case law updates, educational seminars and conferences. Support PRISM Core Values and PRISM Mission. Assist with the overall success of the organizational strategic plan, goals, and objectives of the organization. Lead with a strong customer service focus both internally and externally. Foster member relationships and assist members when needed, including assistance with claims, guidance regarding TPAs, and coordination of post-mortem claim reviews or quarterly claim reviews as requested. A moderate amount of travel will be required. Perform other duties as assigned. Job Requirements Requirements Minimum of 5 years of direct work experience in medical malpractice claims adjusting, reporting, management and settlement work of complex, litigated, catastrophic claims. Or five years of increasingly responsible work in a directly related field, with at least three of those years working in public entity complex or excess casualty environment evaluating complex claims. Bachelor's degree in Business Administration, Risk Management, Public Administration, or a related field. (An equivalent combination of education and relevant experience may be considered) Public Entity claims experience preferred. Coursework or certification in Medical Malpractice Claims, Risk Management, or a related area is desirable. Strong analytical and interpersonal and customer service skills; ability to interact professionally with members, TPAs, and other stakeholders. High degree of professionalism, customer service orientation, and ability to maintain cool in challenging and complex situations. High level of integrity, professionalism, attention to detail, and critical thinking. Proven ability to mentor, train, and guide junior-level staff or peers. Experience working with public agencies or joint powers authorities (JPAs) is a plus. Apply by Tue, 05/26/2026 - 12:00 To Apply, Contact Jill Abel ... ... Events 17 Jun Wednesday San Diego & Imperial Valley Chapter Meeting 31 Jan Sunday PARMA 53rd Annual Conference 2027 22 Feb Tuesday PARMA 54th Annual Conference 2028