Scheduled Hours

40

Position Summary

Analyzes and evaluates complex incident reports and lawsuits, reviews medical records and interviews involved individuals to obtain needed information. Prepares complex investigative analytical reports for Director and Legal Counsel regarding potentially compensable incidents covered by the Self-Insured Professional Liability Program, and other reports as requested by Senior Management. Coordinates case development, case management, and participates in office management.

Job Description

Primary Duties & Responsibilities:

• Conducts internal claims investigations, plans defense strategies and negotiates disposition of assigned files with guidance of legal counsel. Conducts meetings with physicians, analyzes medical record information and event reports; directs approved legal counsel and other legal personnel involved in the defense; evaluates liability and financial exposure, approves expert witness reviews; responds to discovery requests and answers interrogatories; coordinates witness preparations; makes recommendations for resolution of claim; and coordinates meetings with Director, defense counsel and Office of General Counsel to perform decision tree analysis to determine case value.  Attends mediation, arbitration, and/or trial.   
• Prepares and submits required reports to Department Heads, Office of General Counsel, Director of Risk Management, excess insurance carriers, and when applicable, coordinates with external agency investigations, i.e., professional Board inquiries. Responds to general claim inquiries.  
• Establishes indemnity and expense reserves based on the reserving policy.  Negotiates settlements within authority. Reviews and approves defense counsel related invoices and expenses.
• Provides consultation and guidance on healthcare issues such as medical record release, subpoena responses, termination/transfer of care, patient complaints, and physician billing issues including accounts in litigation. Arrange for attorneys to attend depositions with physicians when necessary. Mentors less experienced claims managers.
• Performs other duties as assigned.

      

Working Conditions:

Job Location/Working Conditions

• Normal office environment

Physical Effort

• Typically sitting at a desk or a table

Equipment

• Office equipment

The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all job duties performed by the personnel so classified. Management reserves the right to revise or amend duties at any time.

Required Qualifications

Education:

Bachelor's degree

Certifications/Professional Licenses:

No specific certification/professional license is required for this position.

Work Experience:

Analyzing Or Interpreting Medical Or Other Technical Evidence That Compares In Level Of Complexity To Medical Treatment (5 Years)

Skills:

Not Applicable

Driver's License:

A driver's license is not required for this position.

More About This Job

Preferred Qualifications:

• Analytical ability to evaluate facts and formulate questions in order to define problems and critical events in the medical care rendered.
• General knowledge of The Joint Commission and patient safety standards, diagnosis and treatment of human disease and injury, medical therapies, procedures and standard of medical care.
• Knowledge of methods and techniques of individual case study, recording and file maintenance.
• Seven years’ experience in medical malpractice claims management.

Preferred Qualifications

Education:

No additional education unless stated elsewhere in the job posting.

Certifications/Professional Licenses:

No additional certification/professional licenses unless stated elsewhere in the job posting.

Work Experience:

No additional work experience unless stated elsewhere in the job posting.

Skills:

Analytical Thinking, Defining Problems, Detail-Oriented, Disease Diagnosis, Disease Management, Group Presentations, Injury Treatment, Joint Commission Regulations, Organizational Savvy, Patient Safety, Report Preparation

Grade

G13

Salary Range

$65,900