The Doctors Company · 16 hours ago
Claims Administrative Specialist
Napa, CA
Full-time
Hybrid
New Grad, Entry Level
$46K/yr - $61K/yrThe Doctors Company is the nation’s largest physician-owned medical malpractice insurer, and they are seeking an experienced Claims Administrative Specialist to support their Claims team. The role involves communication with members to create electronic claim files, providing clerical and administrative support, and maintaining accurate coding and file updates for claims processing.
Insurance
Responsibilities
Maintains a broad-based understanding of the company standards and guidelines
Articulates the guidelines to both internal and outside customers as necessary
Seeks to actively meet the expected standards and guidelines in all phases of their work product
Uses appropriate judgment in applying guidelines to achieve the desired outcome
Obtains information and necessary facts to create an electronic claim file. Accurate and timely data entry after confirming coverage under the applicable policy. Refers to designated manager for assignment and follows up
Serves as first point of contact when members, administrators, agents or brokers contact TDC to report a claim file. Utilize phone software during designated work time. As applicable, transfer to appropriate contact and follow-up to obtain required information
Acts as primary contact for member service within their assigned region to provide best imaginable service
Generates all necessary letters for file opening, closing and in support of their assigned claim specialist(s)
Orders death certificates, autopsy reports, statute checks and other public records
Obtains from necessary parties, signed authorizations and orders medical records
Organizes medical records for the claims file and prepares records for expert review
Follows-up on closed files for receipt of dismissal and settlement documents
Performs various processing duties, such as updating computerized claims records, sending facsimiles/emails, telephone support, and servicing the insured throughout the life of the claims file
Completes State Reports and other forms
Receives and follow up on all NPDB coding requests
Acts as large account point person for reporting allocated and unallocated claims
Coordinate meetings and correspondence upon request
Processes manual payments as needed
Prepares accurate settlement check requests and ensures file has Medicare designation
Provides processing assistance for requests from other departments
Manages unallocated files including assignment of defense counsel and monitoring for timely closure
Reviews and approves legal invoices on assigned files
Manages allocated files with reserves below $30,000, which do not require field investigation. Varies by regional office
Performs other duties as assigned
Qualification
Required
Experience in insurance or healthcare industry preferred
Excellent oral and written communication skills
Demonstrates organizational skills and attention to detail
Strong customer service skills and ability to work on a high performing team
Proficiency within Microsoft suit of products, including Word, Excel, and Outlook
Ability to follow departmental procedures with a high degree of accuracy and detail
Ability to prioritize workload to meet pertinent deadlines and response dates
Ability to handle confidential personal health information in accordance with company policy and PHI rules & regulations
Ability to support internal and external stakeholders with diverse backgrounds and personalities
Benefits
Health, dental, and vision insurance
Health and dependent care tax-free spending accounts with a company match
401(k) and Roth IRA with company match, as well as catch-up plans for both
Paid vacation, sick days, and personal days each calendar year (with vacation increases based on length of service)
12 paid holidays each calendar year
Life and travel insurance
Tax-free commuter benefits
In-person and online learning opportunities
Cross-function career opportunities
Business casual work environment
Time off to volunteer
Matching donations to qualifying nonprofit organizations
Company-sponsored participation at non-profit events
Company
The Doctors Company
The Doctors Company is a medical malpractice insurer providing coverage and risk management services to healthcare professionals.
Founded in 1976
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Deepika Srivastava
Chief Operating Officer
Recent News
2025-10-02
Company data provided by crunchbase