Carilion Clinic · 3 weeks ago
Claims Services Consultant
Roanoke, VA
Full-time
Onsite
Mid Level
3+ years expCarilion Clinic is a healthcare organization seeking a Claims Services Consultant to assist with the litigation management process for professional and general liability claims. The role involves collaborating with claims specialists, managing open claims, and ensuring compliance with regulatory requirements.
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Responsibilities
Assists the Director of Claims at Carilion Clinic with the litigation management process for professional and general liability claims
Collaborates with Claims Specialist on the attorney assist process for Carilion
Produces the loss-run and claims management letters on behalf of BRIC insured providers
Assists with BRIC audit process to ensure compliance with regulatory and governmental requirements
The Claims Services Consultant functions as a resource to claims specialists within the department, while managing 50-60% of open claims, independently, as directed by Director of Claims Management
Consults with and gathers information for outside council, providers, employees, and others involved in malpractice filings or insurance investigations or claims history
Communicate receipt of malpractice lawsuit filing or service, notice of potential compensatory event via notification from event reporting system, risk managers, department heads or physicians, or notification from attorney of representation of plaintiff
Communicate with outside attorneys who are providing legal defense to Carilion and its employees
Conduct an investigation, at the direction of defense attorneys, and report findings back to defense Counsel and Director of Claims management
Collect pertinent documents, information and records for litigation as directed by defense counsel
Coordinate meetings with defense counsel and Carilion providers and employees
Coordinate and attend meetings to prepare Carilion employees and providers for depositions
Attend depositions and legal hearings
Communicate with the Director of Claims Management pertinent case information and litigation milestones
Oversees the attorney assist process to ensure compliance with HIPPA and legal requirements
Ensures that appropriate documentation is executed prior to engaging counsel
Assists Dir. of Claims in responding to audit requests to ensure regulatory compliance
Performs trend analysis on claims data as directed by the Dir. of claims management
Reports this data out at various committees and escalates patterns and concerns to the Dir, of Claims management
Oversees and Manages requests regarding insurance verification and claims history information for appointment and reappointment process for: All current or previously employed physicians, All current or previously employed residents, All current or previously employed mid-level providers
Qualification
Required
Registered Nurse (BSN) or bachelor's degree in health science or Paralegal
Minimum three to five years experience required in field
Excellent written and verbal communication skills, with appropriate use of grammar, spelling and/or punctuation
Knowledge of office procedures and equipment
Must have strong organizational skills and be self-motivated
Must be proficient with Microsoft Office Suite including Word, Excel, PowerPoint, Risk Master, and Epic
Must be able to deal with patients, attorneys, and employees at all levels in a diplomatic manner
Preferred
Experience in medical malpractice, healthcare, or the legal field preferred
Advanced education in the field of Risk management or claims management strongly preferred
Company
Carilion Clinic
Carilion Clinic is a health care organization based in Virginia with more than 650 physicians in 70 specialties.
10001+ employees
H1B Sponsorship
Carilion Clinic has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (17)
2024 (19)
2023 (13)
2022 (13)
2021 (15)
2020 (31)
Funding
Current Stage
Late StageTotal Funding
$0.3MKey Investors
CDA FoundationVirginia Innovation Partnership CorporationUnitedHealthcare
2025-04-04Grant
2023-04-18Grant· $0.07M
2022-08-10Grant· $0.23M
Leadership Team
Steve Arner
President / CEO, Carilion Medical Center
Don Halliwill
Chief Financial Officer
Recent News
Research and Markets
2025-11-27
2025-05-05
Company data provided by crunchbase