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Organization TypePublic Interest
Years of Experience
Date Last Verified
ProfileArea Claims Manager Duties: Responsible for strategizing and implementing a cost effective and successful process to manage Hospital Professional Liability (HPL), General Liability (GL) and Employment Practices Liability (EPL) claims and litigation, and co-manages uninsured litigation across the system. 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. Knows, understands, incorporates and demonstrates the mission, vision, and values in behaviors, practices and decisions. Formulates and implements thorough investigation plan for each claim. Evaluates claim with respect to standard of care, liability, causation, and damages. Considers witness credibility and expert opinions and determines the value of the claim. Timely sets appropriate indemnity and expense reserves. In conjunction with defense counsel, establishes a claim resolution strategy, facilitates and communicates same. Obtains settlement authority as established by policy. Within delegated authority limits, independently negotiates or directs the negotiation of the claims/lawsuit to resolution. Notifies excess insurer of selected claims according to established criteria and provides file updates pursuant to reporting guidelines. Maintains a diary system to monitor all open claims. Updates claim files per documentation guidelines. Presents comprehensive information at internal claim reviews and prepares case review material. Represents facility and/or Trinity Health at case evaluations, settlement conferences, facilitations, mediation, and trial. Provides status reports for open and closed claims to facility Risk Manager, facility administrators, committees and others as requested. Retains approved defense counsel on a per claim basis. Directs and supervises the work of outside defense counsel pursuant to the litigation protocol. Reviews and responds to attorney reports and recommendations. Reviews and approves the defense counsel fee and litigation expenses. Participates in the attorney selection and re-evaluation process with legal services, participates in periodic attorney evaluations per policy. Directs and supervises claims specialists, paralegals and claims assistants in handling of claim files, creating reports, database entries and other claim management responsibilities. Provides periodic feedback to staff regarding expectations and performance and completes the performance evaluation process for assigned claims assistant. Responsible for creating, monitoring and updating policies and procedures for the VPP Insurance Program and D&O/EPL lines of coverage. Responsible for cultivation of VPP Insurance Program. Participates and presents at introductory meetings with potential insureds; prepares material, participates and presents at Physician Professional Liability Program (PPLIP) and Physician Management Advisory Committee (PMAC); provides education relative to the program across the system. Directs interviews and hiring process for new claim colleagues. Creates and implements an orientation plan for new ACMs, Paralegals, and Claim Assistants. Provides guidance to new colleagues and evaluates progress to plan. Reviews and approves data prepared for and provided to the Ministry Organizations. Provides guidance and clarity to other team members relating to litigated matters. Responsible for creating, implementing, and monitoring Medicare Secondary Payer reporting process, and adherence to all Federal guidelines. Adheres to IRMS and corporate policy and procedures. Identifies loss control issues and makes recommendations as appropriate. Documents risk modification and risk reduction strategies in file and in STARS. Works collaboratively with loss control directors to identify risk management trends, issues and opportunities. Keeps IRMS management apprised of case developments. Directs and supervises the Claim assistants in maintaining and updating STARS database and reviews at appropriate intervals to promote data integrity. Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
Qualification and Experience
QUALIFICATIONS: 4-year undergraduate degree or equivalent related experience is required. A clinical health care degree and/or graduate degree in law or hospital administration are preferred. Experience as a liability claims professional adjuster, defense malpractice attorney or hospital risk manager is necessary. Supervisory experience preferred. Advanced knowledge and working relationships in risk management, quality management and improvement is helpful. Working knowledge of medical terminology is required. 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 is essential.
Job Number: 00046404
20555 Victor Parkway
Livonia, MI 48152-7018