Sr. Professional Liability Medical Claims Manager Remote

Providence St. Joseph Health • Renton, WA • 1d ago

Description
Providence caregivers are not simply valued - they're invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Providence is calling a Sr. Professional Liability Medical Claims Manager who will:
Investigate, evaluate, and manage professional, general, and other liability claims under the PSJH Insurance Program:
Communicate with patients, claimants, caregivers, providers, leadership
Review and analyze medical records, interview witnesses, assist with the discovery process and communicate with facility risk manager regarding evaluation and investigation
Be responsible for writing insurance policy coverage letters
Analyze insurance policy documents to address coverage
Set appropriate indemnity and expense reserves
Select appropriate medical experts for case review
Develop a plan of action for assigned claims and update the claims file following all material changes in status
Review and approve statements for services and take proper steps to pay vendors
Inform Senior Manager Operations of large or complex claims and claims with potential for media exposure
Report claims with potential excess exposure to excess insurers
Ensure compliance with relevant claims reporting procedures and required regulations
Work with defense attorneys specializing in defense of medical negligence claims
Have direct responsibility to foster teamwork, operational excellence, and effective communication within the claims team, including other Claims Managers, Claims Reps and Claims Specialists
Maintain complete documentation for each matter:
Develop and document for each claim or lawsuit a plan of action for resolution by settlement, trial, or other means
Maintain the electronic file including all material communication, correspondence, analysis, expert opinions, interview summaries and all other material documents in accordance with the Claims Policies and Procedures Manual
Coordinate with facility leadership, risk managers, defense counsel and others:
Select defense counsel when appropriate from approved counsel list
Coordinate and consult with risk management on disclosure conversations with patients and families
Obtain authority for settlement or trial in accordance with policies and procedures or facilitate claims roundtables
Assist in Regional CEO Conferences with Senior Manager Operations
Facilitate and participate in case reviews with Risk Managers upon request
Resolve claims in accordance with policies and regulations:
Negotiate settlements
Monitor trials and advise on disclosure and early resolution opportunities
Report to relevant federal, state, and local regulatory agencies as required
Close files in accordance with internal policies and procedures and facilitate appropriate reporting to NPDB and state agencies
Participate in department and claims team projects as assigned to develop and improve procedures, policies; to improve efficiency of department work; and to assist the SVP Chief Risk Officer and Senior Manager Operations as needed
Provide Input to Reduce Risk:
Provide feedback and recommendations, evaluations, litigation trends, department policies and procedures, system-wide claims and litigation processes, and appropriate System risk management issues
Provide input for quality and patient safety projects, through the Risk & Integrity Services division and Risk, Claims, & Insurance department
Providence welcomes 100% remote work for applicants who reside in the following States:
Alaska
Washington
Oregon
Montana
California
Texas
Requi

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