Providence Health & Services
Sr. Professional Liability Medical Claims Manager *Remote*
Providence Health & Services, Juneau, Alaska, United States
Overview
Sr. Professional Liability Medical Claims Manager (Remote) at Providence Health & Services. This role involves investigating, evaluating, and managing professional, general, and other liability claims under the PSJH Insurance Program. Responsibilities
Communicate with patients, claimants, caregivers, providers, and leadership. Review and analyze medical records, interview witnesses, assist with the discovery process, and communicate with the facility risk manager regarding evaluation and investigation. Write insurance policy coverage letters. Analyze insurance policy documents to address coverage. Set appropriate indemnity and expense reserves. Select appropriate medical experts for case review. Develop a plan of action for assigned claims and update the claims file following material changes in status. Review and approve statements for services and take proper steps to pay vendors. Inform Senior Manager Operations of large or complex 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. Foster teamwork, operational excellence, and effective communication within the claims team, including other Claims Managers, Claims Reps and Claims Specialists. 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 communications, correspondence, analysis, expert opinions, interview summaries, and other material documents in accordance with the Claims Policies and Procedures Manual. Coordinate with facility leadership, risk managers, defense counsel and others: select defense counsel when appropriate from the approved list; coordinate and consult with risk management on disclosure conversations with patients and families; obtain authority for settlement or trial; assist in Regional CEO Conferences; facilitate and participate in case reviews with Risk Managers upon request. Resolve claims in accordance with policies and regulations: negotiate settlements; monitor trials and advise on disclosure and early resolution opportunities; report to federal, state, and local regulatory agencies as required; close files per internal policies and procedures and report to NPDB and state agencies as appropriate; participate in department and claims team projects to improve procedures and efficiency. Provide input to reduce risk: offer feedback on litigation trends, department policies, system-wide claims and risk management issues, and participate in quality and patient safety projects through the Risk & Integrity Services division and Risk, Claims, & Insurance department. Remote work eligibility: Providence welcomes 100% remote work for applicants residing in Alaska, Washington, Oregon, Montana, California, or Texas. Qualifications
Required Qualifications : Bachelor’s Degree in Business Administration, Finance, or related field — 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. Preferred Qualifications
Certified Professional Healthcare Risk Management (CPHRM) 10+ years of medical malpractice experience Insurance Carrier Experience Third Party Professional Negligence Claims Experience Experience handling Medical Negligence Professional Liability Claims Experience handling Complex 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 Remote Work Eligibility by State
Alaska Washington Oregon Montana California Texas Salary Range by Location
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: All Northern 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 About Providence
At Providence, our promise is to know you, care for you, and ease your way. We offer best-in-class benefits and foster an inclusive workplace where diversity is valued and everyone is essential, heard and respected. Our 120,000 caregivers serve in over 50 hospitals and 1,000 clinics across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. The base pay range is listed; additional compensation may be available. Why Join Providence?
We offer comprehensive benefits to support you and your family in staying well, growing professionally and achieving financial security. Providence is an equal opportunity employer that values diversity.
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Sr. Professional Liability Medical Claims Manager (Remote) at Providence Health & Services. This role involves investigating, evaluating, and managing professional, general, and other liability claims under the PSJH Insurance Program. Responsibilities
Communicate with patients, claimants, caregivers, providers, and leadership. Review and analyze medical records, interview witnesses, assist with the discovery process, and communicate with the facility risk manager regarding evaluation and investigation. Write insurance policy coverage letters. Analyze insurance policy documents to address coverage. Set appropriate indemnity and expense reserves. Select appropriate medical experts for case review. Develop a plan of action for assigned claims and update the claims file following material changes in status. Review and approve statements for services and take proper steps to pay vendors. Inform Senior Manager Operations of large or complex 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. Foster teamwork, operational excellence, and effective communication within the claims team, including other Claims Managers, Claims Reps and Claims Specialists. 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 communications, correspondence, analysis, expert opinions, interview summaries, and other material documents in accordance with the Claims Policies and Procedures Manual. Coordinate with facility leadership, risk managers, defense counsel and others: select defense counsel when appropriate from the approved list; coordinate and consult with risk management on disclosure conversations with patients and families; obtain authority for settlement or trial; assist in Regional CEO Conferences; facilitate and participate in case reviews with Risk Managers upon request. Resolve claims in accordance with policies and regulations: negotiate settlements; monitor trials and advise on disclosure and early resolution opportunities; report to federal, state, and local regulatory agencies as required; close files per internal policies and procedures and report to NPDB and state agencies as appropriate; participate in department and claims team projects to improve procedures and efficiency. Provide input to reduce risk: offer feedback on litigation trends, department policies, system-wide claims and risk management issues, and participate in quality and patient safety projects through the Risk & Integrity Services division and Risk, Claims, & Insurance department. Remote work eligibility: Providence welcomes 100% remote work for applicants residing in Alaska, Washington, Oregon, Montana, California, or Texas. Qualifications
Required Qualifications : Bachelor’s Degree in Business Administration, Finance, or related field — 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. Preferred Qualifications
Certified Professional Healthcare Risk Management (CPHRM) 10+ years of medical malpractice experience Insurance Carrier Experience Third Party Professional Negligence Claims Experience Experience handling Medical Negligence Professional Liability Claims Experience handling Complex 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 Remote Work Eligibility by State
Alaska Washington Oregon Montana California Texas Salary Range by Location
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: All Northern 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 About Providence
At Providence, our promise is to know you, care for you, and ease your way. We offer best-in-class benefits and foster an inclusive workplace where diversity is valued and everyone is essential, heard and respected. Our 120,000 caregivers serve in over 50 hospitals and 1,000 clinics across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. The base pay range is listed; additional compensation may be available. Why Join Providence?
We offer comprehensive benefits to support you and your family in staying well, growing professionally and achieving financial security. Providence is an equal opportunity employer that values diversity.
#J-18808-Ljbffr