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As our System Manager, Claims, you will be 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. You will direct facility professionals on claim investigations that produce accurate facts and lead to timely as well as objective analysis of all assignments.Every day, under limited direction, this position will have high levels of authority to negotiate on behalf of the organization with opposing litigants and attorneys to resolve disputes and lawsuits. You will assist in the coaching, training, and mentoring of other team members and serve as a subject matter expert on specialty claims or risks.To be successful in your role, you will strategically manage complex healthcare claims and litigation, ensuring thorough investigation, objective analysis, and effective resolution. You will demonstrate exceptional expertise in negotiation, risk mitigation, and providing specialized guidance, acting as a pivotal resource for both internal teams and external parties to protect the organization's interests and uphold its reputation.
Job Responsibility:
Investigation, evaluation, and disposition of healthcare-related property and/or liability claims and lawsuits that are of a significant and complex nature
Direct facility professionals on claim investigations that produce accurate facts and lead 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 the organization with opposing litigants and attorneys to resolve disputes and lawsuits
Assist in the coaching, training, and mentoring of other team members and serve as a subject matter expert on specialty claims or risks
Strategically manage complex healthcare claims and litigation, ensuring thorough investigation, objective analysis, and effective resolution
Demonstrate exceptional expertise in negotiation, risk mitigation, and providing specialized guidance, acting as a pivotal resource for both internal teams and external parties to protect the organization's interests and uphold its reputation
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
Requirements:
Ten (10) years of high exposure medical malpractice and general liability claim management experience
Ten (10) years of insurance, legal, health care operations, and medical experience
Healthcare system claim experience
Nice to have:
Bachelors Other Bachelor’s Degree – advanced degree
Insurance or claim-related professional course work
What we offer:
Medical, prescription drug, dental, vision plans
Life insurance
Paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually)
Tuition reimbursement
Retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings