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Providence Health & Services General Liability Claims Manager PSJH in Anchorage, Alaska

Description:

Providence St Joseph Health is calling a General Liability Claims Manager PSJH in our location in Spokane, WA.

We are seeking a General Liability Claims Manager PSJH who will be responsible for day-to-day oversight of general and professional liability claims in accordance with the System's claims program policies and procedures and within an assigned Region or scope of responsibility. The 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 Director of Risk & Claims; maintaining up-to-date and accurate claims files, including summaries, action plans, and claims status in the claims data management software; coordinating with facility leadership, risk managers, defense counsel, and others; ensuring compliance with relevant claims reporting procedures and required regulations; and providing feedback and recommendations to the Director of Risk & Claims on evaluations, litigation trends, department policies and procedures, system-wide claims and litigation processes, and appropriate System risk management issues. The Claims Manager will have direct responsibility to foster teamwork, operational excellence and effective communication within the claims team, including other Claims Managers, Claims Technicians and Claims Specialists.

In this position you will:

  • Investigate, Evaluate, and Manage Professional, General and other Liability Claims under the PSJH Insurance Program:

  • Review and analyze medical records, interview witnesses, assist with the discovery process and communicate with facility risk manager regarding evaluation and investigation.

  • In collaboration with facility risk management, set appropriate indemnity and expense reserves including documentation of jury verdict research or similar analysis of exposure.

  • 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.

  • Maintain up-to-date claims status and actions plans on all Potential Claims, Claims and litigated matters in the claims data management software.

  • Resolve Claims In Accordance with Policies and Regulations:

  • Negotiate settlements.

  • Monitor trials.

  • 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.

Qualifications:

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.

  • 5 years Relevant general claims processing or management experience or an equivalent combination of direct legal work (e.g. as a litigator or paralegal), health care or general risk management, and insurance claims handling.

Preferred qualifications for this position include:

  • Certified Professional Healthcare Risk Management (CPHRM).

  • Experience with a mix of general liability claims, including at least 10 claims with significant bodily injury and experience with STARS software.

  • Healthcare experience.

About the department you will serve.

Providence Strategic and Management Services provides a variety of functional and system support services for all eight regions of Providence Health & Services from Alaska to California. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

We offer a full comprehensive range of benefits — see our website for details —http://www.providenceiscalling.jobs/rewards-benefits

We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit

https://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Quality/Risk/Safety (Non-Clinical)

Location: Washington-Spokane

Other Location(s): New Mexico-Hobbs, Alaska-Anchorage, Montana-Missoula, Texas-Lubbock, Oregon-Portland, California-Irvine

Req ID: 325830

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