Sr. Professional Liability Medical Claims Manager *Remote*

Sr. Professional Liability Medical Claims Manager *Remote* Alaska

ReqID : 319856

Job Category : Financial Transactions

Schedule : Full time

Work Location : Providence Valley Office Park-Renton

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 United States.

Note : Providence is not currently considering applicants who reside in the following States :

Hawaii

Massachusetts

New York

Ohio

Pennsylvania

Required qualifications for this position include :

Bachelor's Degree in Business Administration, Finance, or another related field of study -OR- a combination of equivalent education and experience

7+ years of relevant general and professional liability claims processing or management experience

5+ years of direct supervisory or management experience

Preferred qualifications for this position include :

Certified Professional Healthcare Risk Management (CPHRM)

10+ years of medical malpractice experience

Third Party Professional Negligence Claims Experience

Experience handling Medical Negligence Professional Liability Claims

Experience handling Complex General Liability Claims

Experience Investigating, evaluating and negotiating medical negligence claims

Experience working with defense attorneys specializing in defense of medical negligence claims

Experience analyzing medical professional and general liability insurance policy documents and addressing coverage

Experience writing medical professional and general liability insurance policy coverage letters

STARS / Riskonnect or similar claims management software experience

Salary Range by Location :

AK : Anchorage : Min : $51.16, Max : $82.36

California : Humboldt : Min : $53.33, Max : $85.85

California : All Northern California - Except Humboldt : Min : $59.84, Max : $96.32

California : All Southern California - Except Bakersfield : Min : $53.33, Max : $85.85

California : Bakersfield : Min : $51.16, Max : $82.36

Idaho : Min : $45.53, Max : $73.29

New Mexico : Min : $41.19, Max : $66.31

Oregon : Non-Portland Service Area : Min : $47.70 Max : $76.78

Oregon : Portland Service Area : Min : $51.16, Max : $82.36

Texas : Min : $39.02 Max : $62.82

Washington : Western - Except Tukwila : Min : $53.33, Max : $85.85

Washington : Southwest - Olympia, Centralia & Below : Min : $51.16, Max : $82.36

Washington : Tukwila : Min : $53.33, Max : $85.85

Washington : Eastern : Min : $45.53, Max : $73.29

Washington : Southeastern : Min : $47.70 Max : $76.78

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security.

We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of Know me, care for me, ease my way. Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others.

We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected.

Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.

As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more.

Learn more at providence.jobs / benefits .

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 United States.

Note : Providence is not currently considering applicants who reside in the following States :

Colorado

Hawaii

Massachusetts

New York

Ohio

Pennsylvania

Required qualifications for this position include :

Bachelor's Degree in Business Administration, Finance, or another related field of study -OR- a combination of equivalent education and experience

7+ years of relevant general and professional liability claims processing or management experience

5+ years of direct supervisory or management experience

Preferred qualifications for this position include :

Certified Professional Healthcare Risk Management (CPHRM)

10+ years of medical malpractice experience

Insurance Carrier Experience

Third Party Professional Negligence Claims Experience

Experience handling Medical Negligence Professional Liability Claims

Experience handling Complex General Liability Claims

Experience Investigating, evaluating and negotiating medical negligence claims

Experience working with defense attorneys specializing in defense of medical negligence claims

Experience analyzing medical professional and general liability insurance policy documents and addressing coverage

Experience writing medical professional and general liability insurance policy coverage letters

STARS / Riskonnect or similar claims management software experience

Salary Range by Location :

AK : Anchorage : Min : $51.16, Max : $82.36

AK : Kodiak, Seward, Valdez : Min : $53.33, Max : $85.85

California : Humboldt : Min : $53.33, Max : $85.85

California : All Northern California - Except Humboldt : Min : $59.84, Max : $96.32

California : All Southern California - Except Bakersfield : Min : $53.33, Max : $85.85

California : Bakersfield : Min : $51.16, Max : $82.36

Idaho : Min : $45.53, Max : $73.29

Montana : Except Great Falls : Min : $41.19, Max : $66.31

Montana : Great Falls : Min : $39.02 Max : $62.82

New Mexico : Min : $41.19, Max : $66.31

Nevada : Min : $53.33, Max : $85.85

Oregon : Non-Portland Service Area : Min : $47.70 Max : $76.78

Oregon : Portland Service Area : Min : $51.16, Max : $82.36

Texas : Min : $39.02 Max : $62.82

Washington : Western - Except Tukwila : Min : $53.33, Max : $85.85

Washington : Southwest - Olympia, Centralia & Below : Min : $51.16, Max : $82.36

Washington : Tukwila : Min : $53.33, Max : $85.85

Washington : Eastern : Min : $45.53, Max : $73.29

Washington : Southeastern : Min : $47.70 Max : $76.78

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security.

We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of Know me, care for me, ease my way. Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others.

We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected.

Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.

As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more.

Learn more at providence.jobs / benefits .

A variety of soft skills and experience may be required for the following role Please ensure you check the overview below carefully.

About the Team

Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.

We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

Providence is proud to be an Equal Opportunity Employer . We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Pay Range : See Posting

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby / on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.

In addition to medical, dental and vision insurance effective on day one, unique total rewards include :

J-18808-Ljbffr

Remote working / work at home options are available for this role.