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Organization TypePublic Interest
Years of Experience
Date Last Verified
ProfileSenior Claims Manager Duties: Responsible for the personnel, operations, and oversight of claims management of the Regional Claims Office. designs and directs the claim investigation process; evaluates claim with respect to liability, causation and damages; develops a resolution strategy and fairly and equitably resolves claims and lawsuits. Monitors and provides input on Unit staffing needs. Conducts interviews, hires new staff, and provides employee orientation and training to new members of the team. Responsible for motivating and retaining Unit staff, evaluating staff performance, encouraging staff development, recommending salary actions, and, as necessary, developing performance improvement plans and recommending individual terminations of employment. Establishes Unit staff goals and conducts employee performance reviews. Conducts regular reviews of pending and closed files to determine whether claims are managed appropriately; identifies areas for improvement and discusses individual training and development needs as necessary. Evaluates office processes for Unit. Recommends and coordinates needed changes based on process analysis; ensures consistency with IRMS policies and procedures. Ensures Unit staff compliance with required Trinity Health corporate education and compliance. Reviews Unit's claim loss reports, assesses complexity of submitted claims and assigns claims within unit as appropriate; serves as a technical resource for staff as necessary. Serves as liaison to Director of Claims. Facilitates and ensures communication between the Unit and IRMS. Oversees defense counsel for the Unit, to include participation in selection of panel counsel; settling of billing disputes; maintenance of the Defense Attorney Database; oversight of the communication of performance evaluations to defense attorneys; resolution of conflicts pertaining to representation. Supervises the work activities of Unit professional staff in reviewing, analyzing, investigating, negotiating and settling claims in compliance with established standards and expectations. Conducts quality file audits to ensure compliance with IRMS Claims Department best practices. Tracks and communicates Unit performance relating to production, opportunity areas and significant achievements. Monitors and evaluates reserves for claims within the Unit to ensure that they are adequate and that reserve adjustments are made, when necessary, consistent with established time frames. Maintains awareness of existing and proposed legislation, court decisions and emerging trends in claims litigation specific to the Unit's venue. Recommends process and/or procedure changes as appropriate. In accordance with the duties and functions of an Area Claims Manager, maintains an individual caseload commensurate with the amount of time necessary to perform the duties of Senior Claim Manager.
Qualification and Experience
Qualifications: Bachelor's degree or equivalent combination of education or experience. A clinical health care degree and/or advanced degree in law or hospital administration is desirable. 5-7 years' experience as a liability claims professional adjuster, defense malpractice attorney or hospital risk manager is necessary. Working knowledge of medical terminology is necessary. Strong analytical skills are necessary as well as the ability to organize and communicate information both orally and in writing with all levels of the organization. Initiative and the ability to handle responsibility independently are necessary. Ability to meet deadlines and respond to shifting priorities is necessary. Must be comfortable operating in a collaborative, shared leadership environment. A personal presence which is characterized by a sense of honesty, integrity and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals and values of Trinity Health is essential. Must be able to adapt to frequently changing work priorities as well as work under pressure.