Job Details

Overview

Senior Professional Liability Medical Claims Manager This position works remotely. Many states eligible.

Providence is calling a Sr. Professional Liability Medical Claims Manager who will:

Responsibilities

• Investigate, evaluate, and manage professional, general, and other liability claims under the PSJH Insurance Program
• Communicate with patients, claimants, caregivers, providers, leadership
• Review and analyze medical records, interview witnesses, assist with the discovery process and communicate with facility risk manager regarding evaluation and investigation
• Be responsible for writing insurance policy coverage letters
• Analyze insurance policy documents to address coverage
• Set appropriate indemnity and expense reserves
• 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 Senior Manager Operations of large or complex claims and claims with potential for media exposure
• Report claims with potential excess exposure to excess insurers
• Ensure compliance with relevant claims reporting procedures and required regulations
• Work with defense attorneys specializing in defense of medical negligence claims
• Foster teamwork, operational excellence, and effective communication within the claims team, including other Claims Managers, Claims Reps and Claims Specialists

Documentation

• Maintain complete documentation for each matter
• 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

Coordination

• Select defense counsel when appropriate from approved counsel list
• Coordinate and consult with risk management on disclosure conversations with patients and families
• Obtain authority for settlement or trial in accordance with policies and procedures or facilitate claims roundtables
• Assist in Regional CEO Conferences with Senior Manager Operations
• Facilitate and participate in case reviews with Risk Managers upon request

Resolution and Compliance

• Negotiate settlements
• Monitor trials and advise on disclosure and early resolution opportunities
• Report to relevant federal, state, and local regulatory agencies as required
• 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 to develop and improve procedures, policies; to improve efficiency of department work; and to assist the SVP Chief Risk Officer and Senior Manager Operations as needed

Risk Reduction

• Provide feedback and recommendations, evaluations, litigation trends, department policies and procedures, system-wide claims and litigation processes, and appropriate System risk management issues
• Provide input for quality and patient safety projects, through the Risk & Integrity Services division and Risk, Claims, & Insurance department

Qualifications

Required qualifications

• Bachelor's Degree in Business Administration, Finance, or another related field of study -OR- equivalent combination of education and experience in the insurance industry; claims management; or legal handling of claims issues.
• 7 years of relevant general and professional liability claims processing or management experience

Preferred qualifications

• Certified Professional Healthcare Risk Management (CPHRM)
• 10+ years of medical malpractice experience
• Insurance Carrier Experience
• Third Party Professional Negligence Claims Experience
• Experience handling Medical Negligence Professional Liability Claims
• Experience handling Complex General Liability Claims
• Experience Investigating, evaluating, and negotiating medical negligence claims
• Experience working with defense attorneys specializing in defense of medical negligence claims
• Experience analyzing medical professional and general liability insurance policy documents and addressing coverage
• Experience writing medical professional and general liability insurance policy coverage letters
• STARS / Riskonnect or similar claims management software experience

Salary and Location

• Salary Range by Location: AK: Anchorage Min: 52.19, Max: 82.39; AK: Kodiak, Seward, Valdez Min: 54.40, Max: 85.88
• California: Humboldt Min: 54.40, Max: 85.88; California: All Northern California - Except Humboldt Min: 61.04, Max: 96.35; California: Southern California Min: 54.40, Max: 85.88
• Montana: Except Great Falls Min: 42.02, Max: 66.33; Montana: Great Falls Min: 39.81, Max: 62.84
• Oregon: Non-Portland Service Area Min: 48.65, Max: 76.80; Oregon: Portland Service Area Min: 52.19, Max: 82.39
• Texas Min: 39.81, Max: 62.84; Washington: Western Min: 54.40, Max: 85.88
• Washington: Southwest - Olympia, Centralia Min: 52.19, Max: 82.39; Washington: Clark County Min: 52.19, Max: 82.39; Washington: Eastern Min: 46.44, Max: 73.31; Washington: Southeastern Min: 48.65, Max: 76.80
• For states outside those listed above Min: 42.02, Max: 66.33

Why Join Providence?

Our best-in-class benefits are designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." We foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Our 120,000 caregivers serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across multiple states. We are committed to serving the poor and vulnerable with more than 100 years of tradition.

The base pay range is listed; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

About the Team

Providence Shared Services provides functional and system support services for our family of organizations across multiple states. We are focused on supporting our Mission by delivering a robust foundation of services and shared expertise.

Providence is an Equal Opportunity Employer. We are committed to a workplace free from unlawful discrimination and harassment. We value diversity and provide equal opportunities for advancement.

Requisition ID: 388097

Company: Providence Jobs

Job Category: Financial Transactions

Job Function: Health Plans Services

Job Schedule: Full time

Job Shift: Multiple shifts available

Career Track: Business Professional

Department: 4008 SS RIS

Address: WA Renton 1801 Lind Ave SW

Work Location: Providence Valley Office Park-Renton

Workplace Type: Remote

Pay Range: See Posting