Providence St. Joseph Health is calling a Senior Claims Manager PSJH. This position can sit in any state location within the Providence footprint ( AK, WA, OR, CA, MT, NM, TX).
We are seeking a Senior Claims Manager PSJH who will be responsible for day-to-day management of professional and general liability claims in accordance with the System's claims program policies and procedures and within an assigned Region or scope of responsibility. The Senior Claims Manager position will have responsibility for investigating, evaluating and managing professional and other liability claims against the organization as assigned or directed by the Senior Operations Manager; maintaining up-to-date and accurate claims files, including summaries, action plans, and claims status in the claims data management software; communicating directly with patients, claimants, witnesses and families; coordinating with facility leadership, risk managers, defense counsel, and others; monitoring and advising on disclosure and early resolution opportunities; ensuring compliance with relevant claims reporting procedures and required regulations; and providing feedback and recommendations to the Senior Operations Manager on evaluations, litigation trends, department policies and procedures, system-wide claims and litigation processes, and appropriate system risk management issues. The Senior Claims Manager will have direct responsibility to foster teamwork, operational excellence, and effective communication within the claims team, including other Claims Managers, Claims Reps and Claims Specialists.
In this position you will have the following 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.
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 Director of Risk & Claims of large or complex claims and claims with potential for media exposure.
Report claims with potential excess exposure to excess insurers.
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.
Coordinate with Facility and Regional Leaders and Defense Counsel:
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 Director of Risk & Claims.
Facilitate and participate in case reviews with Risk Managers upon request.
Resolve Claims In Accordance with Policies and Regulations:
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 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 Input to Reduce Risk:
Provide feedback and recommendations to the Director of Risk & Claims 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.
Supervise Claims Staff as assigned.
Required qualifications for this position include:
Bachelor's Degree in Business Administration, Finance, or a related discipline -OR- equivalent combination of education and experience in the insurance industry; claims management; or legal handling of claims issues.
7 years relevant general and professional liability claims processing or management experience.
5 years direct supervisory or management experience.
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.