Litigation Claims Analyst
Hasbro Children's
Date: 5 days ago
City: Providence, RI
Contract type: Full time
Summary
Under general supervision of Director Claims Management (Lifespan Risk Services) specializes in investigating and assessing information related to complex claims against hospitals health care clients and indemnified physicians involving highly technical cases such as medical malpractice or product liability. Coordinates management of claims through closure with legal counsel various other insurers and excess insurance carriers. Interviews principals (e.g. claimants witnesses physicians employees) assess pertinent data initiates involvement of appropriate legal and/or insurance services and provides support through the claim process. May provide quality assurance to the claim process by establishing updating and maintaining the processes and protocols used to collect share and store claim information prepare claims correspondence and for the collection storage and sharing of material collected for Discovery.
Responsibilities
Evaluates and analyzes incidents in timely manner that have been identified as potential claims. Determines strengths and weaknesses of each case to decide what strategies can be implemented to avoid litigation and what issues must be analyzed to determine potential financial exposure advises with respect to findings. May act as resource to other claims adjustors to evaluate and plan litigation and assist in claim settlement negotiations.
Provides for or conducts interview of key witnesses and key individuals involved in potential or actual Medical Malpractice General liability Directors & Officers liability Fiduciary Aviation Environmental Cyber Risk Property and Auto claims cases. Assists in development of answers to interrogatories and other similar legal filings. Obtains expert opinion when necessary.
Negotiates within authority claim settlements directly with claimants or their legal representatives/attorneys. Attempts to resolve problems without litigation. Works with attorneys third party administrators and related insurance companies through the claim process.
Prepares documentation for case files and disseminates relevant information to appropriate parties. Maintains current claim information in computer data base and prepares progress notes. Monitors claim files to ensure timely documentation and completeness. May review progress notes of other claims analysts when case reserves exceed a threshold established by Director Claims Management. Assists in development of action plans.
Participates in development of case reserves and recommends changes when required. Assists in development of answers to interrogatories and other similar legal filings.
Reviews confidential material contained in medical records and personnel files abstracting pertinent information and summarizing statistically or in narrative form for review and analysis by President or at request of legal counsel.
Identifies and pursues opportunities to reduce exposure to loss in support of system's total quality management process.
Participates in risk management presentations to medical staff and other employees. Advises with respect to sensitive medical-legal issues.
May prepare case summaries and information for review by the Lifespan Risk Services Physician Claims Committee. Coordinates attorney and expert involvement for the review of cases. Coordinates notices schedules and details necessary for meetings and case reviews.
Maintains knowledge and awareness of current practices techniques trends law and precedents regarding medical malpractice or product liability by participation in ongoing independent study education-related professional activities and affiliations.
Participates in or leads various committees task forces and quality improvement teams as appropriate.
Other Information
BASIC KNOWLEDGE:
Bachelor�s in health care management nursing related field or the equivalent experience required. Master�s or Juris Doctorate degree preferred.
Claim Adjuster�s License in Rhode Island or ability to be obtained within 6 months of employment required.
AIC ARM CPCU CPHRM designations preferred.
Experience
A minimum of 7-10 years� experience in Claims and/or Litigation Risk Management or a clinical setting required.
Experience In The Following Areas Required
Brown University Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Brown University Health is a VEVRAA Federal Contractor.
Location: Lifespan Risk Services USA:RI:Providence
Work Type: Full Time
Shift: Shift 1
Union: Non-Union
Under general supervision of Director Claims Management (Lifespan Risk Services) specializes in investigating and assessing information related to complex claims against hospitals health care clients and indemnified physicians involving highly technical cases such as medical malpractice or product liability. Coordinates management of claims through closure with legal counsel various other insurers and excess insurance carriers. Interviews principals (e.g. claimants witnesses physicians employees) assess pertinent data initiates involvement of appropriate legal and/or insurance services and provides support through the claim process. May provide quality assurance to the claim process by establishing updating and maintaining the processes and protocols used to collect share and store claim information prepare claims correspondence and for the collection storage and sharing of material collected for Discovery.
Responsibilities
Evaluates and analyzes incidents in timely manner that have been identified as potential claims. Determines strengths and weaknesses of each case to decide what strategies can be implemented to avoid litigation and what issues must be analyzed to determine potential financial exposure advises with respect to findings. May act as resource to other claims adjustors to evaluate and plan litigation and assist in claim settlement negotiations.
Provides for or conducts interview of key witnesses and key individuals involved in potential or actual Medical Malpractice General liability Directors & Officers liability Fiduciary Aviation Environmental Cyber Risk Property and Auto claims cases. Assists in development of answers to interrogatories and other similar legal filings. Obtains expert opinion when necessary.
Negotiates within authority claim settlements directly with claimants or their legal representatives/attorneys. Attempts to resolve problems without litigation. Works with attorneys third party administrators and related insurance companies through the claim process.
Prepares documentation for case files and disseminates relevant information to appropriate parties. Maintains current claim information in computer data base and prepares progress notes. Monitors claim files to ensure timely documentation and completeness. May review progress notes of other claims analysts when case reserves exceed a threshold established by Director Claims Management. Assists in development of action plans.
Participates in development of case reserves and recommends changes when required. Assists in development of answers to interrogatories and other similar legal filings.
Reviews confidential material contained in medical records and personnel files abstracting pertinent information and summarizing statistically or in narrative form for review and analysis by President or at request of legal counsel.
Identifies and pursues opportunities to reduce exposure to loss in support of system's total quality management process.
Participates in risk management presentations to medical staff and other employees. Advises with respect to sensitive medical-legal issues.
May prepare case summaries and information for review by the Lifespan Risk Services Physician Claims Committee. Coordinates attorney and expert involvement for the review of cases. Coordinates notices schedules and details necessary for meetings and case reviews.
Maintains knowledge and awareness of current practices techniques trends law and precedents regarding medical malpractice or product liability by participation in ongoing independent study education-related professional activities and affiliations.
Participates in or leads various committees task forces and quality improvement teams as appropriate.
Other Information
BASIC KNOWLEDGE:
Bachelor�s in health care management nursing related field or the equivalent experience required. Master�s or Juris Doctorate degree preferred.
Claim Adjuster�s License in Rhode Island or ability to be obtained within 6 months of employment required.
AIC ARM CPCU CPHRM designations preferred.
Experience
A minimum of 7-10 years� experience in Claims and/or Litigation Risk Management or a clinical setting required.
Experience In The Following Areas Required
- Familiarity with hospital or health care environment
- Claims Handling
- Litigation Management
- Negotiation
- Customer Service
Brown University Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Brown University Health is a VEVRAA Federal Contractor.
Location: Lifespan Risk Services USA:RI:Providence
Work Type: Full Time
Shift: Shift 1
Union: Non-Union
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