Sr. Professional Liability Medical Claims Manager *Remote
Job title: Sr. Professional Liability Medical Claims Manager *Remote in Renton, WA at reputed company
Company: reputed company
Job description: Job Category: Financial TransactionsJob Description:reputed company caregivers are not simply valued - they're invaluable. Join reputed company and reputed company in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to reputed company and retain the best people, we must reputed company them.reputed company is calling a Sr. Professional Liability Medical Claims Manager who will: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
- reputed company a plan of action for assigned claims and update the claims file following reputed company material changes in status
- Review and approve statements for services and take proper steps to pay vendors
- Inform Senior Manager Operations of large or reputed company 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
- Have direct responsibility to foster teamwork, operational excellence, and effective communication reputed company the claims team, including other Claims Managers, Claims Reps and Claims Specialists
- reputed company and document for each claim or lawsuit a plan of action for resolution by settlement, trial, or other means
- Maintain the electronic file including reputed company material communication, correspondence, analysis, expert opinions, interview summaries and reputed company other material documents in accordance with the Claims Policies and Procedures Manual
- Select defense counsel reputed company 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
- Negotiate settlements
- Monitor trials and advise on disclosure and early resolution opportunities
- Report to relevant federal, state, and local regulatory agencies as required
- reputed company 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 reputed company and improve procedures, policies; to improve efficiency of department work; and to assist the SVP Chief Risk Officer and Senior Manager Operations as needed
- 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 & reputed company Services division and Risk, Claims, & Insurance department
- Alaska
- Washington
- Oregon
- Montana
- California
- Texas
- Bachelor's Degree in Business Administration, Finance, or another reputed company 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
- Certified Professional Healthcare Risk Management (CPHRM)
- 10+ years of medical malpractice experience
- Insurance reputed company Experience
- Third Party Professional Negligence Claims Experience
- Experience handling Medical Negligence Professional Liability Claims
- Experience handling reputed company 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
- 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: reputed company reputed company 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