Careers at CAP
Our dedicated employees are the essential element to CAP’s success. For more than 40 years, this team of well-trained professionals with a commitment to excellence has helped deliver to our member physicians an unparalleled quality of products and services. Our corporate culture and collegial collaboration of minds and efforts is unmatched.
Our comprehensive benefits package includes medical, dental vision, life, AD&D, LTD, 401(k) with employer match, PTO and separate sick time, and paid holidays. Join CAP’s workforce and make your contributions to our team.
To apply, please submit your resume with cover letter to HR@CAPphysicians.com
CAP seeks two Senior Claims Specialists, one for its Orange County office and one who can be based anywhere in Southern California, to perform technical and administrative duties to manage assigned claim files; assumes increased workload of highly complex claims. Participates in the continued training and supervision of Claims Specialist I and II’s.
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.
- Employee education and awareness is an important element in the company’s cybersecurity program. Accordingly, the Senior Claims Specialist is responsible for being cautious and vigilant when opening emails, attachments, links, etc. on CAP’s computer equipment or when accessing the company system remotely. It is also the Senior Claims Specialist’s responsibility to complete cybersecurity training modules that are periodically distributed by CAP’s IT department.
- 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
Under the direction of the Vice President, Risk Management & Patient Safety (RMPS), provide risk management consultation and support to physician members and insureds. Provide risk management advice to requests to Hotline and e-mail requests from physicians and their staff. Conduct physician practice risk assessments virtually, or on-site, to promote patient safety practices and to minimize malpractice risk. Analyze claims and other data sources for trends and develop risk reduction strategies. Develop risk management practice guides, templates, educational materials, and other resources for physicians and their staff. Research and write professional RMPS articles. Create and present educational programs on risk management topics and strategies via webinars or in-person. Function as a RMPS resource to other CAP department staff, e.g., Underwriting, Membership Services and Claims departments. Participate in department and organization goals, projects, and committees, as assigned.
Essential Duties and Responsibilities:
- Act as resource to physicians and their staff regarding risk management and other current issues regarding physician/medical practice liability. Communicate effectively with physicians and other healthcare professionals on risk management issues. Manage complex and sensitive issues as they relate to risk reduction strategies for physician practices.
- Provide risk management advice to Hotline and e-mail requests from physicians and their staff. Participate in rotating after-hours (evenings, weekends, & holidays) Hotline coverage, as scheduled. Organize, plan, and conduct virtual, or on-site, physician practice risk assessments to promote patient safety practices and to minimize malpractice risk, as set by department goals. Adhere to current departmental guidelines and standards for scheduling practice visits and timely data entry of interactions with physicians and their staff.
- Function as a RMPS resource to other CAP department staff, e.g., Underwriting, Membership Services and Claims department.
- Analyze claims data and other data sources. Identify trends and develop risk reduction strategies utilizing current best practices.
- Develop risk management practice guides, templates, educational materials, and other resources for physicians and their staff focusing on patient safety and risk management.
- Research and write professional RMPS articles.
- Create and present educational programs on risk management topics and strategies to physicians and other healthcare related groups.
- Participate in RMPS Departmental and organizational meetings, goals, projects, committees, and meetings as requested.
- Participate in Risk Assessment Peer Review meetings, including review of materials, drafting case summaries and minutes, as assigned.
- Train and mentor new Risk Management Specialists as assigned.
- Employee education and awareness is an important element in the company’s cybersecurity program. Accordingly, as Risk Management and Patient Safety Specialist, you are responsible for being cautious and vigilant when opening emails, attachments, links, etc. on CAP’s computer equipment or when accessing the company system remotely. It is also the Risk Management and Patient Safety Specialist’s responsibility to complete cybersecurity training modules that are periodically distributed by CAP’s IT department.
- Perform other duties and projects as assigned.
Education and Experience:
- Bachelor’s degree in a healthcare related field required; master’s degree preferred
- RN, RN/JD, or clinical license preferred
- Five years’ experience in healthcare risk management or equivalent experience in a healthcare related environment
- Professional liability experience highly desirable
- Physician office management or ambulatory care experience preferred
- Experience and participation in patient safety/risk management and quality improvement (QI/QA) activities or committees
- Knowledge of root cause analysis (RCA), adverse event management, responding to grievances and complaints, advance directives and release of protected health information
- Experience identifying educational and learning needs/gaps of healthcare professionals or physician office practices and developing education and providing training to address the needs
- Experience writing articles, healthcare educational material, and professional business correspondence
- Experience in public speaking, e.g., creating and providing presentations to medical personnel or teaching classes
Other Skills and Abilities:
- Excellent verbal and written communication skills
- Excellent customer service skills
- Ability to work independently and collaboratively
- Strong organizational skills
- Maintain a valid California driver license to travel to physician offices or other venues
- Ability to travel to practice locations within California, with occasional overnight stays, when requested
- Computer skills including Microsoft Office, Word, Excel, PowerPoint
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.