Manager, Integrated Case Management
Sharp HealthCare
AWS
Senior Medical Claims Manager – Professional Liability
Providence
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $40 - $96 per hour
Job Level
Senior
About the role
- Investigate, evaluate, and manage professional, general, and other liability claims under the PSJH Insurance Program
- Communicate with patients, claimants, caregivers, providers, and leadership
- Review and analyze medical records, interview witnesses, assist discovery, and coordinate with facility risk managers
- Write insurance policy coverage letters and analyze policy documents to address coverage
- Set indemnity and expense reserves and select medical experts for case review
- Develop and document plans of action for claims resolution and maintain complete electronic claim files
- Coordinate with facility leadership, risk managers, defense counsel, and excess insurers
- Negotiate settlements, monitor trials, report to regulatory agencies, and close files per policies
- Provide feedback and recommendations to reduce risk and support quality and patient safety projects
Requirements
- Bachelor's Degree in Business Administration, Finance, or another related field of study OR equivalent combination of education and experience in the insurance industry; claims management; or legal handling of claims issues.
- 7 years of relevant general and professional liability claims processing or management experience
- Preferred: Certified Professional Healthcare Risk Management (CPHRM)
- Preferred: 10+ years of medical malpractice experience
- Preferred: Insurance carrier experience
- Preferred: Third party professional negligence claims experience
- Preferred: Experience handling medical negligence professional liability claims and complex general liability claims
- Preferred: Experience investigating, evaluating, and negotiating medical negligence claims
- Preferred: Experience working with defense attorneys specializing in defense of medical negligence claims
- Preferred: Experience analyzing medical professional and general liability insurance policy documents and writing coverage letters
- Preferred: STARS / Riskonnect or similar claims management software experience
