Providence Health & Services
Sr. Professional Liability Medical Claims Manager *Remote*
Providence Health & Services, Portland, Oregon, United States, 97204
Overview
Description Providence caregivers are not simply valued - they're invaluable. Join our team and thrive 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 inspire and retain the best people, we must empower them. Providence 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
Responsibilities
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
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 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
Documentation
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
Coordination
Select defense counsel when 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
Resolution and Risk Reduction
Negotiate settlements
Monitor trials and advise on disclosure and early resolution opportunities
Report to relevant federal, state, and local regulatory agencies as required
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 to develop and improve procedures and policies
Support the SVP Chief Risk Officer and Senior Manager Operations as needed
Provide Input to Reduce Risk
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 & Integrity Services division and Risk, Claims, & Insurance department
Remote work eligibility
Providence welcomes 100% remote work for applicants who reside in the following States:
Alaska
Washington
Oregon
Montana
California
Texas
Qualifications Required qualifications for this position include:
Bachelor's Degree in Business Administration, Finance, or another related 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
Preferred qualifications for this position include:
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
Salary
Salary Range by Location details are provided in the posting.
Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About Providence At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." We are an inclusive workplace where diversity is valued and everyone is essential, heard and respected. Our 120,000 caregivers serve across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington, with a long history of serving the poor and vulnerable.
The base pay range is listed; additional compensation may be available, such as shift differentials and bonuses.
About the Team Providence Shared Services provides functional and system support services across multiple states, focused on supporting our Mission.
Providence is an Equal Opportunity Employer. We are committed to a workplace free from unlawful discrimination and harassment. We value diversity and are dedicated to equal opportunities for advancement.
Requisition Details Requisition ID: 385582
Company: Providence Jobs
Job Category: Financial Transactions
Job Function: Health Plans Services
Job Schedule: Full time
Job Shift: Multiple shifts available
Career Track: Business Professional
Department: 4008 SS RIS
Address: WA Renton 1801 Lind Ave SW
Work Location: Providence Valley Office Park-Renton
Workplace Type: Remote
Pay Range: See Posting
#J-18808-Ljbffr
Description Providence caregivers are not simply valued - they're invaluable. Join our team and thrive 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 inspire and retain the best people, we must empower them. Providence 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
Responsibilities
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
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 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
Documentation
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
Coordination
Select defense counsel when 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
Resolution and Risk Reduction
Negotiate settlements
Monitor trials and advise on disclosure and early resolution opportunities
Report to relevant federal, state, and local regulatory agencies as required
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 to develop and improve procedures and policies
Support the SVP Chief Risk Officer and Senior Manager Operations as needed
Provide Input to Reduce Risk
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 & Integrity Services division and Risk, Claims, & Insurance department
Remote work eligibility
Providence welcomes 100% remote work for applicants who reside in the following States:
Alaska
Washington
Oregon
Montana
California
Texas
Qualifications Required qualifications for this position include:
Bachelor's Degree in Business Administration, Finance, or another related 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
Preferred qualifications for this position include:
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
Salary
Salary Range by Location details are provided in the posting.
Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About Providence At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." We are an inclusive workplace where diversity is valued and everyone is essential, heard and respected. Our 120,000 caregivers serve across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington, with a long history of serving the poor and vulnerable.
The base pay range is listed; additional compensation may be available, such as shift differentials and bonuses.
About the Team Providence Shared Services provides functional and system support services across multiple states, focused on supporting our Mission.
Providence is an Equal Opportunity Employer. We are committed to a workplace free from unlawful discrimination and harassment. We value diversity and are dedicated to equal opportunities for advancement.
Requisition Details Requisition ID: 385582
Company: Providence Jobs
Job Category: Financial Transactions
Job Function: Health Plans Services
Job Schedule: Full time
Job Shift: Multiple shifts available
Career Track: Business Professional
Department: 4008 SS RIS
Address: WA Renton 1801 Lind Ave SW
Work Location: Providence Valley Office Park-Renton
Workplace Type: Remote
Pay Range: See Posting
#J-18808-Ljbffr