Providence Health Plan Group
Claims Manager *Remote. Most States Eligible*
Providence Health Plan Group, Granite Heights, Wisconsin, United States
Overview
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, 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 Claims 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 Have direct responsibility to foster teamwork, operational excellence, and effective communication within the claims team, including other Claims Managers, Claims Reps and Claims Specialists 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
Coordinate with facility leadership, risk managers, defense counsel and others 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 Claims Facilitate and participate in case reviews with Risk Managers upon request Claims Resolution
Resolve claims in accordance with policies and regulations 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 as assigned to develop and improve procedures and policies; to improve efficiency of department work; and to assist senior leadership as needed Risk Reduction
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 Qualifications
Required: Bachelor\'s Degree in Business Administration, Finance, or a 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 (e.g., as a litigator or paralegal), health care 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 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 Experience with STARS / Riskonnect or similar claims management software Salary Range by Location
AK: Anchorage: Min: 45.14, Max: 70.07; AK: Kodiak, Seward, Valdez: Min: 47.05, Max: 73.04; California: Humboldt: Min: 47.05, Max: 73.04; California: All Northern California - Except Humboldt: Min: 52.79, Max: 81.94; California: All Southern California - Except Bakersfield: Min: 47.05, Max: 73.04; California: Bakersfield: Min: 45.14, Max: 70.07; Montana: Except Great Falls: Min: 36.34, Max: 56.41; Montana: Great Falls: Min: 34.43, Max: 53.44; Oregon: Non-Portland Service Area: Min: 42.08, Max: 65.32; Oregon: Portland Service Area: Min: 45.14, Max: 70.07; Texas: Min: 34.43, Max: 53.44; Washington: Western - Except Tukwila: Min: 47.05, Max: 73.04; Washington: Southwest - Olympia, Centralia & Below: Min: 45.14, Max: 70.07; Washington: Tukwila: Min: 47.05, Max: 73.04; Washington: Eastern: Min: 40.16, Max: 62.35; Washington: South Eastern: Min: 42.08, Max: 65.32; States outside those listed above: Min: 36.34, Max: 56.41 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.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. We are a large system serving across multiple states. The base pay range is listed; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including retirement plans, health care, life insurance, disability insurance, paid time off, voluntary benefits, well-being resources, and more. Learn more at providence.jobs/benefits. Applicants in certain jurisdictions will be considered in accordance with applicable fair chance laws.
About the Team
Providence Shared Services is a service line within Providence that provides a variety of functional and system support services across multiple states. We are focused on supporting our Mission by delivering a robust foundation of services and sharing specialized expertise. Providence is an Equal Opportunity Employer. We are committed to an inclusive workforce where diversity is valued and everyone is essential, heard and respected.
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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, 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 Claims 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 Have direct responsibility to foster teamwork, operational excellence, and effective communication within the claims team, including other Claims Managers, Claims Reps and Claims Specialists 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
Coordinate with facility leadership, risk managers, defense counsel and others 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 Claims Facilitate and participate in case reviews with Risk Managers upon request Claims Resolution
Resolve claims in accordance with policies and regulations 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 as assigned to develop and improve procedures and policies; to improve efficiency of department work; and to assist senior leadership as needed Risk Reduction
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 Qualifications
Required: Bachelor\'s Degree in Business Administration, Finance, or a 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 (e.g., as a litigator or paralegal), health care 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 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 Experience with STARS / Riskonnect or similar claims management software Salary Range by Location
AK: Anchorage: Min: 45.14, Max: 70.07; AK: Kodiak, Seward, Valdez: Min: 47.05, Max: 73.04; California: Humboldt: Min: 47.05, Max: 73.04; California: All Northern California - Except Humboldt: Min: 52.79, Max: 81.94; California: All Southern California - Except Bakersfield: Min: 47.05, Max: 73.04; California: Bakersfield: Min: 45.14, Max: 70.07; Montana: Except Great Falls: Min: 36.34, Max: 56.41; Montana: Great Falls: Min: 34.43, Max: 53.44; Oregon: Non-Portland Service Area: Min: 42.08, Max: 65.32; Oregon: Portland Service Area: Min: 45.14, Max: 70.07; Texas: Min: 34.43, Max: 53.44; Washington: Western - Except Tukwila: Min: 47.05, Max: 73.04; Washington: Southwest - Olympia, Centralia & Below: Min: 45.14, Max: 70.07; Washington: Tukwila: Min: 47.05, Max: 73.04; Washington: Eastern: Min: 40.16, Max: 62.35; Washington: South Eastern: Min: 42.08, Max: 65.32; States outside those listed above: Min: 36.34, Max: 56.41 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.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. We are a large system serving across multiple states. The base pay range is listed; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including retirement plans, health care, life insurance, disability insurance, paid time off, voluntary benefits, well-being resources, and more. Learn more at providence.jobs/benefits. Applicants in certain jurisdictions will be considered in accordance with applicable fair chance laws.
About the Team
Providence Shared Services is a service line within Providence that provides a variety of functional and system support services across multiple states. We are focused on supporting our Mission by delivering a robust foundation of services and sharing specialized expertise. Providence is an Equal Opportunity Employer. We are committed to an inclusive workforce where diversity is valued and everyone is essential, heard and respected.
#J-18808-Ljbffr