The Claims Consultant assists the Director of Claims 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.
Oversee the attorney assist process to ensure compliance with HIPPA and legal requirements.
Ensure appropriate documentation is executed prior to engaging counsel.
Assist the Dir. of Claims in responding to audit requests to ensure regulatory compliance.
Perform 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.
About Carilion
This is Carilion Clinic ...
An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious.
Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.
Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. Make your tomorrow with us.
Requisition Number: 142619 Employment Status: Full time Location: CASB - Carilion Administrative Services Building Shift: Day Shift Details: 8:30am- 5pm Recruiter: DAVID L NIVEN Recruiter Phone: 540-983-4057 Recruiter Email: dlniven@carilionclinic.org For more information, contact the HR Service Center at 1-800-599-2537.
Equal Opportunity Employer
Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity
Carilion Clinic is a drug-free workplace.
Carilion Total Rewards
What matters to you is important to us—like benefits, rewards, and resources to improve your life. Carilion understands the importance of prioritizing your well-being to help you develop and thrive. When you make your tomorrow with us, we’ll enhance your potential to realize the best in yourself. Below are benefits available to you when you join Carilion:
Employer Funded Pension Plan, vested after five years (Voluntary 403B)
Comprehensive Medical, Dental, & Vision Benefits
Flexible Work Arrangements/Schedules
Remote Work Options
Paid Time Off (accrued from day one)
Onsite fitness studios and discounts to our Carilion Wellness centers
Access to our health and wellness app, Virgin Pulse
Discounts on childcare
Continued education and training
Find more about Carilion Clinic’s benefits by vising our Total Rewards Page.
Equal Opportunity Employer Minorities/Females/Protected Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity Carilion Clinic is a drug-free workplace.
What We Require:
Education: Registered Nurse (BSN) or bachelor’s degree in health science or Paralegal.
Experience: Minimum three to five years experience required in field. Experience in medical malpractice, healthcare, or the legal field preferred.
Licensure, Certification, and/or Registration: Advanced education in the field of Risk management or claims management strongly preferred.
Other Minimum Qualifications: 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.
Carilion Clinic is a not–for–profit health care organization based in Roanoke, Va. Through our comprehensive network of hospitals, primary and specialty physician practices and other complementary services, we work together to provide quality care close to home for nearly 1 million Virginians. With an enduring commitment to the health of our region, we also seek to advance care through medical education and research, help our community stay healthy and inspire our region to grow stronger.
