REMOTE- Area Claims Manager

Employment Type:

Full time

Shift:

Day Shift

Description:

Responsible for strategizing and implementing a cost effective and successful process to manage Hospital Professional Liability (HPL), General Liability (GL) and Employment Practices Liability (EPL) claims and litigation, and co-manages uninsured litigation across the system. Designs and directs the claim investigation process; evaluates claim with respect to liability, causation and damages; develops a resolution strategy and fairly and equitably resolves claims and lawsuits.

Knows, understands, incorporates and demonstrates the Trinity Health mission, vision, and values in behaviors, practices and decisions.

Formulates and implements thorough investigation plan for each claim. Evaluates claim with respect to standard of care, liability, causation, and damages. Considers witness credibility and expert opinions and determines the value of the claim. Timely sets appropriate indemnity and expense reserves.

In conjunction with defense counsel, establishes a claim resolution strategy, facilitates and communicates same. Obtains settlement authority as established by policy. Within delegated authority limits, independently negotiates or directs the negotiation of the claims/lawsuit to resolution.

Notifies excess insurer of selected claims according to established criteria and provides file updates pursuant to reporting guidelines.

Maintains a diary system to monitor all open claims. Updates claim files per documentation guidelines.

Presents comprehensive information at internal claim reviews and prepares case review material.

Represents facility and/or Trinity Health at case evaluations, settlement conferences, facilitations, mediation, and trial.

Provides status reports for open and closed claims to facility Risk Manager, facility administrators, committees and others as requested.

Retains approved defense counsel on a per claim basis. Directs and supervises the work of outside defense counsel pursuant to the litigation protocol. Reviews and responds to attorney reports and recommendations as appropriate. Reviews and approves the defense counsel fee and litigation expenses.

Participates in the attorney selection and re-evaluation process with legal services, participates in periodic attorney evaluations per policy.

Directs and supervises claims specialists, paralegals and claims assistants in handling of claim files, creating reports, database entries and other claim management responsibilities. Provides periodic feedback to staff regarding expectations and performance and completes the performance evaluation process for assigned claims assistant.

Responsible for creating, monitoring and updating policies and procedures for the VPP Insurance Program and D&O/EPL lines of coverage.

Responsible for cultivation of VPP Insurance Program. Participates and presents at introductory meetings with potential insureds; prepares material, participates and presents at Physician Professional Liability Program (PPLIP) and Physician Management Advisory Committee (PMAC); provides education relative to the program across the system.

Directs interviews and hiring process for new claim colleagues. Creates and implements an orientation plan for new ACMs, Paralegals, and Claim Assistants. Provides guidance to new colleagues and evaluates progress to plan.

Reviews and approves data prepared for and provided to the Ministry Organizations. Provides guidance and clarity to other team members relating to litigated matters.

Responsible for creating, implementing, and monitoring Medicare Secondary Payer reporting process, and adherence to all Federal guidelines.

Adheres to IRMS and Trinity Health corporate policy and procedures.

Identifies loss control issues and makes recommendations as appropriate. Documents risk modification and risk reduction strategies in file and in STARS. Works collaboratively with loss control directors to identify risk management trends, issues and opportunities.

Keeps IRMS management apprised of case developments as appropriate.

Directs and supervises the Claim assistants in maintaining and updating STARS database and reviews at appropriate intervals to promote data integrity.

Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

MINIMUM QUALIFICATIONS

4-year undergraduate degree or equivalent related experience is required. A clinical health care degree and/or graduate degree in law or hospital administration are preferred.

Experience as a liability claims professional adjuster, defense malpractice attorney or hospital risk manager is necessary. Supervisory experience preferred.

Advanced knowledge and working relationships in risk management, quality management and improvement is helpful.

Working knowledge of medical terminology is required.

Strong analytical skills are necessary as well as the ability to organize and communicate information both orally and in writing with all levels of the organization.

Initiative and the ability to handle responsibility independently are necessary.

Ability to meet deadlines and respond to shifting priorities is necessary. Must be comfortable operating in a collaborative, shared leadership environment.

A personal presence which is characterized by a sense of honesty, integrity and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals and values of Trinity Health is essential.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

This position operates in a typical office environment. The area is well-lit, temperature controlled and free from hazards and barriers.

Travel to the various Trinity Health sites up to 50% of the time. (Travel to meet with other related parties at various locations is expected).

Must be able to adapt to frequently changing work priorities as well as work under pressure.

Must be able to perform moderate physical activity, lifting and bending.

** Hourly pay range: $48.82 - $80.55

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran