Under general supervision, the Risk & Claims Specialist is responsible for providing administrative, secretarial, and database support for the Risk Management and Patient Relations Department and regional affiliate locations to support risk functions as indicated by Risk Management Director.  The Risk and Claims Specialist assists in coordination of the daily activities of the Risk Management Department including receiving, triaging, and resolving patient complaints, inputting data into department software systems, developing reports, and assisting in coordination of medical malpractice claims at the direction of the Risk Management Director and/or the Risk and Claims Coordinator and Risk and Claims Analyst.  Works closely with Billings Clinic and its affiliate sites to coordinate general and medical malpractice claims insured by Billings Clinic’s insurance company.  Participates in the day-to-day coordination of the department’s fiscal assets and personnel support.  Responsibilities include the development and maintenance of essential databases and reporting processes for risk management related initiatives, accessing, extracting, synthesizing and verification of clinical and financial information, and report generation to support identification and evaluation of trends. Acts as a resource to diverse types of end users, employees and leadership regarding data support services and outcomes. Participates in assisting the Risk Management Director in the development of operating and capital budgets for related sites. May represent the department and/or affiliate sites in non-clinical committees.  

Essential Job Functions
• Works collaboratively with Patient Safety to fulfill the organization’s and affiliate sites strategic initiatives for patient safety management and improvement. 
• Participating in the education of and assisting Risk Management Director, Risk and Claims Coordinator and Risk and Claims Analyst and affiliate site Leadership teams in identifying and capitalizing upon opportunities for improvement
• Participates in identification and arranging for consulting assistance from internal or external sources as required to meet the needs of the Risk Management Committee, medical staff, or others requiring patient safety and risk management education.
• Assists in establishing and maintaining processes to measure customer satisfaction including analysis, routine reporting of complaint and grievance data, and recommendations on findings
• Assists in the development and delivery of annual training and education in FDA reporting.
• Coordinates dissemination of FDA recalls to pertinent departments within the organization.
• Participates in the collaborative design, coordination and management of an organizational wide Risk Management Plan that organizes both risk prevention measures and claims processing and management systems for Billings Clinic and regional affiliate sites. 
• Acts as one of the primary departmental contacts for resolution of customer complaints and issues related to the quality of patient care and/or services, threats of legal action, and imminent safety/risk situations including mandatory reporting to FDA for potential and/or serious patient/employee injury or death resulting from a medical device. Adherence to state and federal disclosure of health information obligation and restrictions is critical. Maintains all legal case files and ensures maximum protection from discoverability.  
• Actively participates at the direction of the Risk Management Director and/or Risk and Claims Coordinator in the assessment and evaluation of liability insurance coverage.  
• Assists Risk Management Director and Risk and Claims Coordinator and Risk and Claims Analyst with coordination of Billings Clinic and affiliate site medical malpractice claims.
• Participates in the development and maintenance of risk management profiles on individual physicians and ensures integration of that information into the credentialing process in compliance with requirements for state and federal agencies, affiliate site and Billings Clinic.  
• Receives, inputs, codes, monitors follow up and closes complaint and grievance reports. Responsible for overall maintenance of the Feedback system.  
• Works with the Risk Management Director, Risk and Claims Coordinator and Risk and Claims Analyst in the development and communication of department specific, Billings Clinic and/or affiliate site policies and procedures. Coordinates closely with the Risk Management Director, Risk & Claims Coordinator and Risk and Claims Analyst on complex issues. 
• Works directly with the Risk Management Director in both short, and long-term planning for the department and/or affiliate. Participates in development of the department annual budget; maintains budget variances within acceptable standards. (Resource Management, Department Planning, Assists with Department Budget)
• Organizes, prioritizes, and performs data management project work to support the organizational strategic initiatives for risk management. Works with a variety of departments to access, extract, synthesize, and verify clinical and financial information. Summarizes, formats and generates a variety of monthly, quarterly and annual reports to support identification and evaluation of trends in risk management and patient relations. (Project Management, Analyze, Data Management)
• Maintains database integrity to ensure authenticity, confidentiality, and effective utilization in support of the organizational strategic initiatives. Coordinates and accesses information through the use of various databases, software applications such as statistical packages, database tools (Access & Excel), clinical/financial databases and safety databases.