Director of Claims and Litigation

Primary City/State:

Arizona, Arizona

Department Name:

Litigation & Claims Mgmt

Work Shift:

Day

Job Category:

Legal

Great careers are built at Banner Health. There’s more to health care than doctors and nurses. We support all staff members as they find the path that’s right for them. Apply today, this could be the perfect opportunity for you.

A network with resources for leaders with vision.  We value and celebrate equity, diversity and inclusion by promoting a culturally-rich workforce. Our leaders are at the forefront of the health care transformation, planning the future of Banner Health.

This role is remote for Arizona residents with a Monday - Friday schedule , flexible around general business hours. In this role you will manage claims and litigation case information and filings and will work alongside the defense counsel.

Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits.

Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits. In addition, this position may be eligible for our Management Incentive Program as part of your Total Rewards package.

Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care.

POSITION SUMMARY
This position is responsible for strategizing and implementing a cost effective and successful process to manage Hospital and Physician Professional Liability (HPPL), General Liability (GL) and Employment Practices Liability (EPL) claims and litigation and co-manages other insured and uninsured litigation across the Banner Health (BH) system upon request. Designs and directs the claims investigation process; evaluates each claim with respect to liability (standard of care -SOC), causation and damages; develops a resolution strategy and fairly and equitably resolves claims and lawsuits.

CORE FUNCTIONS
1. Knows, understands, incorporates and demonstrates the mission, vision, values, brand, strategic initiatives, core measures and core behaviors into leadership behaviors, practices and decisions. Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of BH with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.

2. Formulates and implements a thorough investigation plan for each claim. Evaluates each claim with respect to standard of care, liability, causation, and damages. Determines whether a preservation hold has been or needs to be issued. Considers witness credibility and consultants/expert opinions and determines the value of the claim. Determines and sets appropriate indemnity and expense reserves in a timely manner and periodically re-evaluates such reserves. Maintains a diary system to monitor all open claims. Updates claim files per documentation guidelines. Apprises Director of Claims and VP Business Health of case developments as appropriate. Obtains settlement authority as established by policy. Within delegated authority limits, independently negotiates or directs the negotiation of the claims/lawsuits to resolution. Represents facility, physician, and or BH at case evaluations, pre-mediation meetings with families and mediators, mediations and trial. Notifies reinsurer of selected claims according to established criteria and provides file updates pursuant to reporting guidelines.

3. Responsible for obtaining, entering data into claim file and monitoring such data in order to comply with deadlines for meeting Medicare, Medicaid, Ship Extension Act (MMSEA) reporting requirements in relation to claimants and others releasing medicals. Responsible for determining amounts of liens, rights of recovery and rights of reimbursement with regard to Medicare Secondary Payer Act, other state, federal, and private third party payers and adheres to all state and federal laws, rules and regulations.

4. Participates in the attorney selection and re-evaluation process with the Director of Claims and VP Business Health. Retains approved defense counsel on a per claim basi