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Claims Manager

Company: PeaceHealth
Location: Medford
Posted on: December 5, 2019

Job Description:

PeaceHealth is seeking a Claims Manager for a 1.0 full time equivalent Exempt position. This position will be working Day shift with shift durations of 8 Hours. Req ID: 174936 JOB SUMMARY Position is responsible for the investigation, evaluation, adjudication and resolution of claims and lawsuits presented against PeaceHealth consistent Premier claims management expectations. ESSENTIAL FUNCTIONS Investigates significant events, claims and lawsuits presented against caregivers, physicians and facilities for liability, causation and damages. Interviews principal defendants, fact and expert witnesses completes required captioned reports. Analyzes and evaluates completed investigation and makes recommendations regarding settlement authority, trial or Alternative Dispute Resolution methods. Contacts non-represented claimants presenting demands for compensation beyond waiver of medical bills and analyzes liability, causation and damages to determine exposure and resolves claims by denial, settlement or alternative resolution. Establishes reserves for all litigated and non-litigated claims and lawsuits according to the claims procedure policy. Contacts claimant’s attorneys when notified of legal representation and exchanges discoverable information, based upon HIPPA and federal and state privacy rules to permit evaluation of claims and resolves such claims by denial or settlement with the claimant’s attorney. Manages litigated cases including directing defense attorneys, attending key depositions, mediations, settlement conferences and select portions of trials. Determines the utilization of adjunct claims management services such as litigation stress consultants, witness preparation consultations, focus groups, mock juries and other independent consultants as needed in each case. Coordinates the production of documents, interviews of witnesses and depositions with the regional risk managers. Reviews requested documents before releasing to defense counsel. Attends quarterly claims strategy conference calls. Participates in conference calls with excess insurance carriers as needed. Provides progress reports to physicians and key nursing staff as investigation develops. Informs all targeted practitioners of the impact of federal (NPDB), state (MQAC), insurance and PeaceHealth underwriting guidelines concerning settlements, awards and verdicts. Compiles high-level reports from events, claims and lawsuits using sophisticated data analytic tools. Enters data into the STARS data system for document management. Provides advice to practitioner and administrators. Performs other duties as assigned. QUALIFICATIONS EDUCATION: Bachelor’s degree in Business Administration, Insurance, Legal or Healthcare related field and/or equivalent education/experience is required. Clinical background and/or Juris Doctorate strongly preferred. EXPERIENCE/TRAINING: A minimum of five years in the negotiation and settlement of physician medical malpractice liability claims and management of litigated professional liability cases is required. Experience in the resolution of complex medical malpractice cases, involving potential exposure required. Sophisticated data management experience and skills for presentation and reporting such as SQL, SAP, Crystal Reports, Excess, Access, Tableau, etc. OTHER SKILLS: Excellent face to face interview skills. Strong written and verbal communication skills. Ability to work with physicians and nurses of all specialties. Ability to lead practitioners to a committed resolution in litigated and non-litigated cases. Excellent stewardship skills. Ability to objectively collect and analyze data. Proficient with MS Office applications. SYSTEM SERVICES - PHYSICAL/COGNITIVE REQUIREMENTS: Work requires fairly light physical exertion from up to 65% of the time. Ability to lift objects weighing 30 lbs. or less. Work is performed under normal working conditions with adequate lighting and ventilation. Job duties frequently require intense concentration and attention to detail (up to 65% of work time). Please apply online to be considered. For full consideration of your skills and abilities, please attach a current resume with your application. About PeaceHealth PeaceHealth, based in Vancouver, Wash., is a not-for-profit Catholic health system offering care to communities in Washington, Oregon, and Alaska. PeaceHealth has approximately 16,000 caregivers, a multi-specialty medical group practice with more than 900 providers and 10 medical centers serving both urban and rural communities throughout the Northwest. In 1890, the Sisters of St. Joseph of Peace founded what has become PeaceHealth. Today, PeaceHealth is the legacy of its founding Sisters and continues with a spirit of respect, stewardship, collaboration and social justice in fulfilling its Mission. We offer competitive compensation, a robust benefits package and a collaborative, Mission-driven work environment! To learn more about working at PeaceHealth and the Vancouver community please visit our homepage: www.peacehealth.org/careers . Get a feeling for the Spirit of PeaceHealth through this three-minute video , and visit us on Facebook or LinkedIn ! Questions? Review our Employment FAQ or email Recruitment@peacehealth.org . Please note this email does not accept resumes or applications. Location: Vancouver, Shared Services Center (802) Job Category: Business, Administrative & Facilities Shift: Day Shift Length: 8 Hours FTE: 1.0 Work Type: Full Time Required Certifications/Licensure: PeaceHealth is committed to providing equal employment opportunities to all qualified job applicants and employees without regard to the following statuses: protected veteran; qualified individual with a disability; race; ethnicity; religion; gender; pregnancy; gender identity; national origin; age; genetic information; sexual orientation; or any other protected status in accordance with local, state, or federal laws. The above information is intended to indicate the general nature and level of work performed by this position. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of caregivers assigned to this job. Posting Notes: Vancouver || Business, Administrative & Facilities || Risk Management & Quality || Full Time || RISK MANAGEMENT Nearest Major Market: Portland Oregon Nearest Secondary Market: Tacoma Job Segment: Claims, Underwriter, Medical, ERP, Social Media, Insurance, Healthcare, Technology, Marketing

Keywords: PeaceHealth, Medford , Claims Manager, Other , Medford, Oregon

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Claims Manager
Description: PeaceHealth is seeking a Claims Manager for a 1.0 full time equivalent Exempt position. This position will be working Day shift with shift durations of 8 Hours. Req ID: 174936 JOB SUMMARY Position (more...)
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