Our Director of Claims Management is responsible for managing the Company’s professional and general liability claims and a team of claims litigation specialists. Responsibilities will include risk and claims management activities such as working with the patient safety program, producing and analyzing claims and risk management data, conducting risk management educational programs, and working with the Clinical Risk Managers, all with the objective of effectively managing and reducing the company’s claim exposure.Will be expected to contribute to company efforts to improve patient safety and care through knowledge gained in managing the company’s professional liability claims and will be responsible for reviewing and formulating policy for organizational changes and making recommendations for program improvements.
JD Degree required, B.S. Nursing desired.
Experienced Litigation Attorney, preferably professional liability cases.
At least ten years of experience in Risk or Medical Malpractice Claims management.
Hands on experience with medical claim negotiations.
Must be able to direct and manage a claims litigation team.
Strong knowledge of medical malpractice claims especially in the handling of claims in litigation.
Excellent understanding of entire litigation process including all aspects of a claim to reduce contents to a written report that summarizes the claim.
Ability to learn how to utilize an electronic RMIS/Claims system.
JD, ASHRAM certification, CPCU, AIC, medical malpractice, Nursing/Medical Certifications.
1.Ultimately responsible for Claims Litigation Team which has the following responsibilities and duties: Responsible for personal caseload of medical malpractice claims. Plans strategies for and carries out proactive claim investigations. Prepares written summaries of claim investigations. Compiles, analyzes and documents medical and legal information for claim files. Interprets coverage contracts/policies, analyzes coverage issues and makes recommendations for declinations of coverage, reservation of rights letters and tenders of defense. Suggests appropriate case reserves and reserves changes as necessary. Updates claims database and paperless file as needed. Selects, directs and monitors defense counsel and ensures compliance with the Litigation Management Guidelines and Claims Department Procedures. Communicates effectively with members/insureds, brokers, counsel, experts, and other key contacts as necessary. Maintains personal contact with assigned accounts and provides proactive claims advice. Attends mediations, court hearings, trials and meetings with counsel as necessary. Makes recommendations for claims resolution and negotiates settlements in accordance with Claims Department Procedures. Effectively manages litigation expenses and reviews and approves invoices of defense counsel, experts and vendors.
2. Develops and analyzes statistical trending and patterns of losses delineating risk of loss versus cost of reducing risk, as well as assists with development and maintenance of an efficient and effective claims management program including but not limited to loss control and prevention activities with regular reports to leadership.
3. Ensures data integrity for Claims Litigation Team who are assigned to geographic regions consistent with data requirements. Uses and refines system generated reports to improve performance.
4. Serves as a member of the Risk, Claims and Insurance Team to design, implement and manage risk management and claims department policies, procedures and tools to promote patient safety and quality measures while also limiting exposure to liability. This includes but is not limited to creating risk management surveys to assist in long and short-term planning of proposed changes, working with Clinical Staff to develop and maintain risk profiles on physicians to coordinate integration of risk and claims processes into the credentialing process, overseeing investigations of events that could lead to financial loss and assist to determine liability and medical write-offs for potentially compensable events. Works collaboratively with facility and clinical leadership to assess risks and exposure to the organization.
5. Coordinates discovery responses to assure substantive consistency across entire team / litigation portfolio.
6. Evaluates claim related correspondence from attorneys, patients and other outside sources to formulate responses up to and including settlements, as well as records, collects, documents, maintains and communicates information necessary to assist counsel in pending litigation, while ensuring legal and insurance privileges are protected from inappropriate disclosure and production. Directs and manages Claims litigation team and defense attorneys in all litigation matters.
7. Directs and coordinates release of records and information and personnel appearances in response to subpoenas, court orders, attorney requests, state and federal agency investigations and other inquiries from outside sources.
8. Assists with medical-legal inquiries from physicians, nurses, leaders and others regarding patient care issues and risk mitigation as well as with identifying, communicating and complying with regulatory requirements and maintains awareness of legislative activities that may affect CCS risk and claims programs.
9. Directs, manages and supervises Claims staff to ensure timely review of reports, events in assigned geographic region, identification of potentially compensable events, appropriate investigation of potentially compensable events including collaboration with patient safety staff without waiving privilege, appropriate establishment of financial reserves on all potentially compensable events and claims, managing litigation discovery requests/depositions and appropriate guidance to defense attorneys when required.
10. Must be able to apply principles of critical thinking to a variety of practical and emergent situations and accurately follow standardized procedures that may call for deviations.
11. Must be able to apply sound judgment beyond a specific set of instructions and apply knowledge to different factual situations.
12. Must be alert at all times; pay close attention to details.
13. Must be able to work under stress on a regular or continuous basis.
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