Providence Health Plan Group
Claims Manager *Remote. Most States Eligible*
Providence Health Plan Group, Billings Metropolitan Area, Montana, United States
Overview
Description Providence is calling a Liability 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, and leadership.
Review and analyze medical records, interview witnesses, assist with the discovery process, and communicate with facility risk managers regarding evaluation and investigation.
Be responsible for writing insurance policy coverage letters and analyzing 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 status changes.
Review and approve statements for services and take proper steps to pay vendors.
Inform Senior Manager Claims of large or complex claims and claims with potential media exposure.
Report claims with potential excess exposure to excess insurers; ensure compliance with relevant reporting procedures and regulations.
Work with defense attorneys specializing in defense of medical negligence claims.
Foster teamwork, operational excellence, and effective communication within the claims team and with related roles.
Documentation
Maintain complete documentation for each matter, including a plan of action for resolution by settlement, trial, or other means.
Maintain electronic files with all material communications, analyses, expert opinions, interview summaries, and other documents in accordance with Claims Policies and Procedures.
Coordination
Coordinate with facility leadership, risk managers, and defense counsel; select defense counsel from an approved list when appropriate.
Coordinate disclosure conversations with patients and families; obtain settlement or trial authority per policies and procedures.
Assist in regional leadership conferences and participate in case reviews with Risk Managers as requested.
Risk Reduction
Provide feedback, evaluations, litigation trends, and input on policies, procedures, and risk management issues.
Contribute to quality and patient safety projects within Risk & Integrity Services and the Claims & Insurance departments.
Qualifications
Bachelor's degree in Business Administration, Finance, or related discipline, or an equivalent combination of education and experience in the insurance industry, claims management, or legal handling of claims issues.
5 years of relevant general claims processing or management experience or an equivalent combination of direct legal work, healthcare or general risk management, and insurance claims handling.
Preferred qualifications
Certified Professional Healthcare Risk Management (CPHRM).
2 years of healthcare professional liability claims processing or management experience.
Insurance carrier experience; experience handling medical negligence and complex general liability claims.
Experience with defense of medical negligence claims and analyzing policy documents and coverage letters.
Experience with STARS, Riskonnect, or similar claims management software.
Location and Benefits
Salary ranges are location-based and may vary by area. Providence offers a comprehensive benefits package including retirement, health care, life insurance, disability, paid time off, and well-being resources. Eligible applicants will be considered without regard to race, color, religion, sex, national origin, disability, or veteran status. Why Join Providence?
Our best-in-class benefits are designed to support you and your family in staying well, growing professionally, and achieving financial security. We focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. About Providence: We are a diverse, inclusive workplace serving across multiple states with over 120,000 caregivers. We value diversity and equal opportunities for advancement.
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Description Providence is calling a Liability 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, and leadership.
Review and analyze medical records, interview witnesses, assist with the discovery process, and communicate with facility risk managers regarding evaluation and investigation.
Be responsible for writing insurance policy coverage letters and analyzing 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 status changes.
Review and approve statements for services and take proper steps to pay vendors.
Inform Senior Manager Claims of large or complex claims and claims with potential media exposure.
Report claims with potential excess exposure to excess insurers; ensure compliance with relevant reporting procedures and regulations.
Work with defense attorneys specializing in defense of medical negligence claims.
Foster teamwork, operational excellence, and effective communication within the claims team and with related roles.
Documentation
Maintain complete documentation for each matter, including a plan of action for resolution by settlement, trial, or other means.
Maintain electronic files with all material communications, analyses, expert opinions, interview summaries, and other documents in accordance with Claims Policies and Procedures.
Coordination
Coordinate with facility leadership, risk managers, and defense counsel; select defense counsel from an approved list when appropriate.
Coordinate disclosure conversations with patients and families; obtain settlement or trial authority per policies and procedures.
Assist in regional leadership conferences and participate in case reviews with Risk Managers as requested.
Risk Reduction
Provide feedback, evaluations, litigation trends, and input on policies, procedures, and risk management issues.
Contribute to quality and patient safety projects within Risk & Integrity Services and the Claims & Insurance departments.
Qualifications
Bachelor's degree in Business Administration, Finance, or related discipline, or an equivalent combination of education and experience in the insurance industry, claims management, or legal handling of claims issues.
5 years of relevant general claims processing or management experience or an equivalent combination of direct legal work, healthcare or general risk management, and insurance claims handling.
Preferred qualifications
Certified Professional Healthcare Risk Management (CPHRM).
2 years of healthcare professional liability claims processing or management experience.
Insurance carrier experience; experience handling medical negligence and complex general liability claims.
Experience with defense of medical negligence claims and analyzing policy documents and coverage letters.
Experience with STARS, Riskonnect, or similar claims management software.
Location and Benefits
Salary ranges are location-based and may vary by area. Providence offers a comprehensive benefits package including retirement, health care, life insurance, disability, paid time off, and well-being resources. Eligible applicants will be considered without regard to race, color, religion, sex, national origin, disability, or veteran status. Why Join Providence?
Our best-in-class benefits are designed to support you and your family in staying well, growing professionally, and achieving financial security. We focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. About Providence: We are a diverse, inclusive workplace serving across multiple states with over 120,000 caregivers. We value diversity and equal opportunities for advancement.
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