Liability Claims Manager

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

This is a remote position in the US, California specific work knowledge is desired, but not required to reside in California.

JOB SUMMARY / PURPOSE

This position is responsible for the investigation, evaluation, and disposition of healthcare related property and/or Liability Claims and lawsuits that are of a significant and complex nature. Directs facility professionals on claim investigations that produce accurate facts and leads to timely as well as objective analysis of all assignments. Under limited direction, this position will have high levels of authority to negotiate on behalf of CommonSpirit Health with opposing litigants and attorneys to resolve disputes and lawsuits against CommonSpirit Health. This position will assist in the coaching; training and mentoring of other team members and serve as a subject matter expert on specialty claims or risks (e.g. Hospital, Physician, General Liability, Employment, Directors and Officers, Perinatal, Cardiovascular, Credentialing, Data Privacy, etc.)

ESSENTIAL KEY JOB RESPONSIBILITIES 

• Settlement authority up to $500,000.
• Utilizes best practice claim management techniques and provides high levels of customer service: investigates, evaluates and resolves complex claims and litigation in accordance with CommonSpirit Health Core Values and ERMG policies and procedures.
• Conducts full investigations and evaluations on reported claims or suits. Directs MBO professionals and retained legal counsel to develop and implement a focused strategy for timely and cost-effective resolution of complex claims and suits.
• Hires, directs, evaluates, and terminates (when appropriate) outside defense counsel. Hiring responsibilities include establishing hourly rates, acceptable use of associates and paralegals, and overall minimum service requirements.
• Through claim analysis, assesses economic and non-economic risk to CommonSpirit Health and establishes appropriate financial reserves for budgeting, financial and underwriting reporting.
• Coordinates and directs litigation with assigned defense counsel through proper selection, implementing specific action plans to complete case analysis and claim disposition plans.
• Communicates and builds consensus with facility and divisional leadership on their recommended claim resolution strategy.
• Implements agreed upon settlement or defense strategies that protects the reputation and resources of local facilities and CommonSpirit Health.
• Directly negotiates settlements on high valued claims or lawsuits with opposing litigants and legal counsel.
• Serves as the primary technical expert and consultant for an assigned Service Line, Division, or Market.
  

#LI-CSH

Required Education and Experience:

• Bachelor’s Degree required; Advanced degree or law degree desirable
• Minimum of ten (10) years of high exposure medical malpractice and general liability claim management experience
• Minimum of ten (10) years of insurance, legal, health care operations, and medical experience
• Healthcare system claim experience
• Insurance or claim-related professional course work strongly preferred

Licensure:

AIC, ARM, CPCU, SCLA designations strongly preferred

Required Minimum Knowledge, Skills, Abilities and Training

• Must have advanced claim management, insurance, legal, health care operations and medical knowledge
• Ability to read, analyze and interpret common medical, scientific and technical journals, financial reports and legal documents
• Ability to respond to sensitive inquiries and complaints from customers, regulatory agencies or any member of the business community
• Ability to prepare presentations and correspondence using original or innovative techniques or styles. Ability to present on controversial or complex topics to senior management
• Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions and decimals. Ability to compute rate, ratios and percent.
• Strong analytical and decision-making skills
• Ability to remain open minded with high initiative level.
• Ability to work with physicians and other medical providers
• Ability to work within a matrix organizational structure with multiple stakeholders
• Mentoring, coaching and training peers experience
• Proficient use of technology; including Google Office, Google Docs, Google Mail, web-based applications and risk management information systems.