Department Name:
Litigation & Claims Mgmt
Work Shift:
Day
Job Category:
Legal
Banner Health believes leadership matters. We look for leaders who share our vision making health care easier, so life can be better. Our executives are at the forefront of the health care transformation, planning the future of Banner Health.
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 providing strategic and operational leadership to the claims and litigation management team. This includes implementation of best practices, financial responsibility for performance of claims including oversight of claim reserves and outcomes, and providing legal advice and direction related to risk management incidents, potential claims, claims and litigated matters. This leader provides direct reporting to the company's offshore captive insurance company board, and regularly interacts with domestic and international insurance market contacts. This position oversees, leads and mentors Claims Directors managing their own caseloads and the Claims team as a whole and is also active in strategies, mediations and trials with cases involving potential for high exposure and ensures cost effective and successful management of Hospital and Physician Professional Liability (HPPL), General Liability (GL) and Employment Practices Liability (EPL) and other liability claims and litigation. The leader coordinates with other risk area functions including clinical risk management and risk finance to implement strategic initiatives designed to reduce the financial impact of liability risk and claims on the organization.
CORE FUNCTIONS
Provides leadership and direction to ensure cost effective and successful management of liability claims and litigation, including interacting with senior leaders of BH in decision-making on large litigation matters, the handling of claim files, creating reports, database entries, establishing and following standardized claims management procedures and other claims management responsibilities. Creates, monitors, and updates policies and procedures. Serves as a role-model for the organization's mission, vision, values, and behaviors.
Provides direction and legal advice to Claim Directors and Specialists on claims and litigation matters and is active in management of cases with high potential exposure. Establishes and implements standardized excess reporting guidelines and reviews and responds to queries regarding excess carrier reports and loss runs. Oversees trial preparation for major claims. Within delegated authority limits, independently negotiates or directs the negotiation of the claims/lawsuits to resolution. Represents facility, physician, and/or organization at case evaluations, pre-mediation meetings with families and mediators, mediations, and trial.
Provides legal advice and counsel to employees, leadership, and captive insurer relating to risk management issues, risk mitigation issues, and settlement and litigation strategies. Provides legal advice and direction to the organization with respect to incidents, potentially compensable events, claims, or suits. Directs privileged investigations.
Develops, participates in and coordinates internal and external claims audits, and leads claims team roundtable and reserve review processes. Monitors for and identifies system claim trends, as well as industry benchmarks. Prepares claims data reports and prepares case review materials. Presents comprehensive information at internal claim reviews and status reports to facility leadership, risk managers, facility administrators, medical staffs, various committees, executives and other as requested.
Participates in the attorney selection and re-evaluation process. Retains approved defense counsel on a per claim basis and directs and supervises the work of outside defense counsel pursuant to litigation protocol. Partners with defense counsel to establish a claim resolution strategy, facilitates and communicates same. Provides guidance and clarity to other team members relating to litigated matters.
Leads and oversees the process and policies for establishing timely, appropriate and reliable indemnity and expense reserves and reserve and settlement authority. Oversees the creation of reports and metrics for tracking key aspects of claims and litigation to optimally manage the team, report to senior leaders and to the captive insurance program. Regularly reviews all reserving guidelines, claims best practice guidelines, forms, processes, and team structure for optimally managing liability claims.
Collaborates with senior leaders and key stakeholders or experts, (e.g., Clinical Risk Management, Care Management, including Patient Safety, Legal, etc.) to develop system-wide responses to risk issues that impact specific groups or the entire System with policies/procedures, guidelines, tools, forms, and education/training. Participate and present, as directed, at System committees and captive insurance company board meetings and meetings with insureds and insurance underwriters. Coordinate and collaborate with other functional areas to assist in developing and/or maintaining programs that promote early identification and reporting of events involving serious injuries or probable liability, and prompt investigation, disclosure, and proactive intervention to resolve potential liability events. Develop processes and benchmarks to monitor the effectiveness of risk mitigation strategies.
Oversees investigation and evaluation of complex claims and manages such claims through mediation and/or trial. Negotiates directly with claimants and attorneys on serious liability exposures. Supervises and mentors others in the claims management department. Responsibility for the direction and management of clinical risk management and patient relations. Requires extensive interaction with all levels of senior management, physicians, CEO's, internal management, other BH personnel, attorneys, mediators, insurance companies, business personnel, and government agencies. Directs attorney-client privileged investigations. Has independent authority to resolve claims on behalf of the organization within established authority levels. Uses specialized knowledge and independent judgment to make operational, financial, and strategic decisions affecting outcomes throughout the company.
MINIMUM QUALIFICATIONS
Bachelor's Degree in a relevant field or equivalent level of education and experience.
Expert-level working knowledge of principles, practices, and operations in assigned or related area of responsibility as normally obtained through a minimum of five to seven years of progressively responsible managerial experience, including a minimum of two to three years management level experience within a healthcare system setting or other large multi-operational, complex corporate environment.
This position requires completion of a Juris Doctorate (J.D.) and admission to at least one state bar, and a minimum of five to seven years medical professional liability management experience, either as in-house claims professional or outside counsel. Must gain admission to AZ bar through reciprocity or in-house counsel provision. Must demonstrate expert-level knowledge and awareness of area of expertise in designated facility, business entity or area and/or experience in which the knowledge, skills, and abilities are directly transferrable. Proven track record of driving successful performance outcomes and accomplishing organizational goals.
Must demonstrate skills and business acumen through direct leadership experiences such as: anticipating and responding to the needs of internal and external customers; managing a budget and financial plans; building partnerships with management, staff, and stakeholders to achieve goals and objectives; managing problems and situations where uncertainty is inherent; persuading others to adopt a particular stance on an issue; developing and evaluating best practices and emerging trends for organizational applicability and appropriateness; constructing new and innovative solutions for complex and varying problems and situations while considering the larger perspective or @context; mentoring and coaching staff by providing open and honest feedback to enhance performance; developing and implementing strategic goals and initiatives that support organizational success; demonstrating excellent human relations, organizational and communication skills; and demonstrating a passion for continuously improving and providing high quality care and service excellence to customers, patients, families, employees and/or physicians.
PREFERRED QUALIFICATIONS
Strong negotiating skills and advanced knowledge of healthcare claims, risk management, quality management and performance improvement preferred. Knowledge of in-house liability claims management processes and procedures and other related healthcare regulatory and/or litigation experience preferred. Prior managerial experience.
Additional related education and/or experience preferred.
Estimated Pay Range:
$73.76 - $140.84 / hour
Banner Health is committed to pay equity and transparency. The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting.
This range is based on possible base salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.
EEO Statement:
EEO/Disabled/Veterans (https://www.bannerhealth.com/careers/eeo)
Our organization supports a drug-free work environment.
Privacy Policy:
Privacy Policy (https://www.bannerhealth.com/about/legal-notices/privacy)
EOE/Female/Minority/Disability/Veterans
Banner Health supports a drug-free work environment.
Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability
