Job Description

Directs Claims Management Program including, but not limited to Professional Liability, Employment Practices Liability, and Directors’ and Officers’ Liability. Manages a team and provides guidance on case strategies and caseload execution; prioritizes and monitors claims filed, evaluates insurance coverage, ensures reporting of claims to primary and excess insurance, conducts and/or manages claims audits; evaluates and monitors reserves; oversees defense counsel. Manages individual caseload as assigned.

Job Responsibility

Leads the Claims Management group by communication with and developing staff members, and building consensus for programs and goals that support a business, function or geographic area. Provides leadership to Claims Management team members and supervisors by communicating and guiding toward achieving department objectives. Develops and articulates a short-term strategic vision for areas of responsibility.  Manages a comprehensive, integrated process for litigating non-workers’ compensation claims for the organization and its affiliates; manages a team of 2-4 staff members; oversees team caseload in addition to individual caseload of assigned claims; ensures reporting of claims to insurance carriers. Conducts insurance coverage analyses; reviews and evaluates insurance carrier coverage responses including reservation or rights and coverage denials; evaluates loss runs to ensure adequate reserving of claims at all layers of primary and excess coverage; oversees third party claims and defense counsel in the management of all aspects of assigned claims including day-to-day management, case reserves, expenses and motion practice. Maintains current claim information in the database and oversees case metrics and analytics; ensures appropriate expert reviews; evaluates claims focusing on exposure, severity, reserves, and trial dates; monitors cases on trial and attends trials, when necessary. Identifies cases requiring early/pre-trial resolution; collects and reviews claims data to identify trends and opportunities for loss control; collaborates with risk management to recommend loss control initiatives; serves as a liaison between the organization, Third Party Claims Administrator and Insurance Broker in all aspects of claims management. Monitors claims impacting on the health system's Insurance Captive Insurance company, Self Insurance Program and/or deductibles; reviews insurance and related provisions of written agreements; develops programs and presentations to educate staff members on risk management issues and trends; identifies potential litigation exposures and works with Legal Affairs, Quality Management, colleagues within Risk Management and other administrative staff, as well as outside professionals (when appropriate) to minimize risks arising from such exposures. Acts as a resource to the Insurance team in the evaluation and resolution of general liability matters; leads and implements best practices of the Professional Liability claims administration, including establishing departmental processes and procedures; orients, mentors, and manages direct reports; recommends, implements, and adheres to approved operating goals, objectives and budget; reports operational performance, justification, and/or corrective action. Selects, develops, manages, and evaluates direct reports; oversees the selection, development, management, and evaluation of indirect reports; builds and maintains productive intra-departmental work relationships to optimize operations; ensures operating compliance with government and agency regulations. Manages resources including operating budget, supplies, equipment, space, staff, and information; recommends, implements, and evaluates the approved operating budget; maintains records, reports on performance, and recommends corrective action or justifies variances; plans and ensures adequate supplies on-hand. Evaluates equipment and recommends maintenance, repair, upgrade, or replacement; participates in the planning and utilization of space; oversees the maintenance and integrity of conventional and computer-aided records and information. Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not essential functions.

Job Qualification

Juris Doctor required. 8-12 years of relevant experience and 7+ years of leadership / management experience, required.
*Additional Salary Detail
The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).