Our Senior Claims Examiner (SCE) is responsible for management of all insurance claims, with emphasis on professional and general liability claims, including maintaining risk management information system (RMIS), interfacing with legal counsel and insurance carriers to promptly investigate, evaluate liability and if indicated, settle or resolve the claim, with the goal of reducing the cost of risk. Knowledge of a variety of approaches to loss control., excellent communication, active listening and professional presentation skills are required in this role.
Evaluate potential exposure, report matters meeting criteria to excess carriers, negotiate and settle claims in order to avoid prolonged and expensive litigation.
Verify coverage and timely reporting of medical incidents, claims and lawsuits to the appropriate insurance carrier(s). Identifying and notifying director of potential coverage issues.
Perform in-house investigations, which may include reviewing medical records, interviewing staff, corresponding with parties, gathering and quantifying specials, and assessing liability and exposure
Evaluate and recommend indemnity and expense claim reserves.
Maintain current diary, establish and document plans for disposition for all open claims.
Negotiate settlements directly with claimants or claimant’s attorneys; denying those with no merit.
Work in collaboration with the department director and defense counsel to develop case strategies and preparation of defense.
Attend settlement conferences, depositions, mediations and trials.
Maintain claim documentation in physical files and RMIS database pursuant to Claim Manual requirements.
Ensure defense counsel adheres to guidelines
Ensure excess carriers are provided regular updates, as required by policy.
Ensure the consistency and integrity of data entered into the claim database for the purpose of reporting and analysis of experience.
Assist in preparation of loss runs or other reports as needed.
Review patient safety alerts, analyzes aggregate reports in an effort to identify trends and implement risk control techniques to eliminate the exposure or minimize the loss.
Collaborate with Patient Safety and Performance Improvement in developing material for educating staff in the prevention of future claims.
Investigate and complete Safe Medical Device Act voluntary reporting form when indicated.
Responsible for reporting claims and lawsuits meeting Medicare, Medicaid and SCHIP Extension Act (MMSEA) reporting criteria to CMS.
Minimum of five (5) years’ experience in managing claims and lawsuits preferably for a healthcare entity. Claims experience includes conducting investigations and interviews, reviewing medical records, assessing liability, negotiating and settling claims.
Must have or be able to obtain all Lines License within nine (9) months from date of hire.
AIC, ARM or CPCU certification preferred.
Problem solving skills and ability to resolve conflict.
Effective investigational skills and abilities.
Thorough understanding of liability insurance.
Understanding of claim related legal concepts.
Ability to effectively educate other professionals.
Excellent interpersonal and conflict resolution skills required.
Bilingual (English/Spanish) a plus but not required
Internal Number: 2019-4266
About Salem Health
Salem Health does more than provide high quality patient care. It is an organization that commits itself to empowering teams to create, innovate, and dream. We are looking for individuals who can challenge the status quo, raise the bar, and embrace change.
At Salem Health, we want trailblazers, self-starters, and creative thinkers to drive improvement in the health care arena where “patient-centered” is more than just words.
As a leader in the local industry, Salem Health offers a generous total rewards package, an empowering culture, and a commitment to the development and growth of our in-house talent. Our work is grounded in respect for people and continuous improvement and we invite you to partner with us to further our mission.
Salem Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.