Providence Health & Service
Sr. Professional Liability Medical Claims Manager *Remote, Many States Eligible*
Providence Health & Service, New York, New York, United States
Overview
Description
Senior Professional Liability Medical Claims Manager. Providence is seeking a qualified professional to manage professional, general, and other liability claims under the PSJH Insurance Program. The role supports a patient-focused culture and requires collaboration with care teams, leadership, and risk management. Providence caregivers are valued and empowered to deliver compassionate, whole-person care. Your voice matters here. Responsibilities
Investigate, evaluate, and manage professional, general, and other liability claims under the PSJH Insurance Program. 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 management regarding evaluation and investigation. Draft insurance policy coverage letters; analyze 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 with status changes. Review and approve statements for services; coordinate payments to vendors; inform Senior Manager Operations of large or complex claims or claims with potential media exposure. Report claims with potential excess exposure to excess insurers; ensure compliance with relevant claims 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. Documentation and Coordination
Maintain complete documentation for each matter; develop and document a plan of action for settlement, trial, or other resolution; maintain electronic files with all material communications and analyses in accordance with policy. Coordinate with facility leadership, risk managers, and defense counsel; select defense counsel from approved list; obtain settlement or trial authority as per policies; facilitate claims roundtables; assist in Regional CEO Conferences with Senior Manager Operations; participate in case reviews with Risk Managers as requested. Compliance and Resolution
Resolve claims in accordance with policies and regulations; negotiate settlements; monitor trials; advise on disclosure and early resolution opportunities; report to federal, state, and local regulatory agencies as required; close files per internal policies and report to NPDB and state agencies. Participate in department and claims team projects to improve procedures and department efficiency; support the SVP Chief Risk Officer and Senior Manager Operations as needed. Qualifications
Required: Bachelors 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) or equivalent 10+ years of medical malpractice experience Insurance carrier experience; third-party professional negligence claims experience Experience handling medical negligence and complex general liability claims Experience investigating, evaluating, and negotiating medical professional and general liability claims Experience working with defense attorneys in medical negligence defense Experience analyzing and addressing coverage in medical professional and general liability policies; experience writing coverage letters STARS / Riskonnect or similar claims management software experience Salary and Location
Salary range varies by location; see posting for specifics. Why Join Providence?
Our best-in-class benefits 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
Providence is an inclusive, equal opportunity employer with a history of serving communities across multiple states. We value diversity and strive to create equal opportunities for advancement. The base pay range is shown in postings; additional compensation may include shift differentials, on-call, overtime, premiums, and bonus opportunities. Providence offers a comprehensive benefits package, including retirement plans, health care benefits, life and disability insurance, paid time off, voluntary benefits, and well-being resources. Learn more at providence.jobs/benefits. Equal Employment Opportunity Statement: Providence is an Equal Opportunity Employer committed to an inclusive workplace free from discrimination and harassment. #J-18808-Ljbffr
Description
Senior Professional Liability Medical Claims Manager. Providence is seeking a qualified professional to manage professional, general, and other liability claims under the PSJH Insurance Program. The role supports a patient-focused culture and requires collaboration with care teams, leadership, and risk management. Providence caregivers are valued and empowered to deliver compassionate, whole-person care. Your voice matters here. Responsibilities
Investigate, evaluate, and manage professional, general, and other liability claims under the PSJH Insurance Program. 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 management regarding evaluation and investigation. Draft insurance policy coverage letters; analyze 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 with status changes. Review and approve statements for services; coordinate payments to vendors; inform Senior Manager Operations of large or complex claims or claims with potential media exposure. Report claims with potential excess exposure to excess insurers; ensure compliance with relevant claims 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. Documentation and Coordination
Maintain complete documentation for each matter; develop and document a plan of action for settlement, trial, or other resolution; maintain electronic files with all material communications and analyses in accordance with policy. Coordinate with facility leadership, risk managers, and defense counsel; select defense counsel from approved list; obtain settlement or trial authority as per policies; facilitate claims roundtables; assist in Regional CEO Conferences with Senior Manager Operations; participate in case reviews with Risk Managers as requested. Compliance and Resolution
Resolve claims in accordance with policies and regulations; negotiate settlements; monitor trials; advise on disclosure and early resolution opportunities; report to federal, state, and local regulatory agencies as required; close files per internal policies and report to NPDB and state agencies. Participate in department and claims team projects to improve procedures and department efficiency; support the SVP Chief Risk Officer and Senior Manager Operations as needed. Qualifications
Required: Bachelors 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) or equivalent 10+ years of medical malpractice experience Insurance carrier experience; third-party professional negligence claims experience Experience handling medical negligence and complex general liability claims Experience investigating, evaluating, and negotiating medical professional and general liability claims Experience working with defense attorneys in medical negligence defense Experience analyzing and addressing coverage in medical professional and general liability policies; experience writing coverage letters STARS / Riskonnect or similar claims management software experience Salary and Location
Salary range varies by location; see posting for specifics. Why Join Providence?
Our best-in-class benefits 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
Providence is an inclusive, equal opportunity employer with a history of serving communities across multiple states. We value diversity and strive to create equal opportunities for advancement. The base pay range is shown in postings; additional compensation may include shift differentials, on-call, overtime, premiums, and bonus opportunities. Providence offers a comprehensive benefits package, including retirement plans, health care benefits, life and disability insurance, paid time off, voluntary benefits, and well-being resources. Learn more at providence.jobs/benefits. Equal Employment Opportunity Statement: Providence is an Equal Opportunity Employer committed to an inclusive workplace free from discrimination and harassment. #J-18808-Ljbffr