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Company

Providence · 1 day ago

General Liability Claims Manager, Healthcare

Idaho, United States

Full-time

Remote

Mid, Senior Level

$51.74/hr - $81.90/hr

5+ years exp

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Responsibilities

Be responsible for day-to-day oversight of general and professional liability claims in accordance with the System's claims program policies and procedures and within an assigned Region or scope of responsibility

Be responsible for investigating, evaluating and managing professional and other liability claims against the organization as assigned

Maintain up-to-date and accurate claims files, including summaries, action plans, and claims status in the claims data management software

Coordinate with facility leadership, risk managers, defense counsel, and others; ensuring compliance with relevant claims reporting procedures and required regulations

Provide feedback and recommendations to the Management on evaluations, litigation trends, department policies and procedures, system-wide claims and litigation processes, and appropriate System risk management issues

Be directly responsible for fostering teamwork, operational excellence and effective communication within the claims team, including other Claims Managers, Claims Technicians and Claims Specialists

Review and analyze medical records, interview witnesses, assist with the discovery process and communicate with facility risk manager regarding evaluation and investigation

In collaboration with facility risk management, set appropriate indemnity and expense reserves including documentation of jury verdict research or similar analysis of exposure

Select appropriate medical experts for case review

Develop a plan of action for assigned claims and update the claims file following all material changes in status

Review and approve statements for services and take proper steps to pay vendors

Inform Management of large or complex claims and claims with potential for media exposure

Report claims with potential excess exposure to excess insurers

Develop and document for each claim or lawsuit a plan of action for resolution by settlement, trial or other means

Maintain the electronic file including all material communication, correspondence, analysis, expert opinions, interview summaries and all other material documents in accordance with the Claims Policies and Procedures Manual

Maintain up-to-date claims status and actions plans on all Potential Claims, Claims and litigated matters in the claims data management software

Negotiate settlements

Monitor trials

Close files in accordance with internal policies and procedures and facilitate appropriate reporting to NPDB and state agencies

Participate in department and claims team projects as assigned to develop and improve procedures, policies; to improve efficiency of department work; and to assist the Group Vice President and Director of Risk & Claims as needed

Provide feedback and recommendations to Management regarding claims trends and appropriate risk management responses

Provide input for quality and patient safety projects, through the Risk & Integrity Services division and Risk, Claims, & Insurance department

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

General Liability Claims ProcessingGeneral Liability Claims ManagementHealthcare Risk ManagementInsurance General Liability Claims HandlingGeneral Risk ManagementSTARS softwareCertified Professional Healthcare Risk ManagementBusiness AdministrationFinanceMedical Records AnalysisClaims Data Management Software

Required

Bachelor's Degree in Business Administration, Finance, or a related discipline -OR- a combination of equivalent education and experience

5+ Years of experience in any of the following areas of focus / specialty: General Liability Claims Processing, General Liability Claims Management, General Liability Legal Experience (E.G. Paralegal, Etc.), Healthcare Risk Management, General Risk Management, Insurance General Liability Claims Handling