Job Details

Sr. Professional Liability Medical Claims Manager

Providence is calling a Sr. Professional Liability Medical Claims Manager who will:

• 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
• Foster teamwork, operational excellence, and effective communication within the claims team
• 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

Description, Many states eligible.

Senior Professional Liability Medical Claims Manager This position works remotely. Many states eligible.

Providence caregivers are not simply valued theyre 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
• Foster teamwork, operational excellence, and effective communication within the claims team

Required Qualifications For This Position Include

• 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 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 varies by location; see posting for details.

About Providence

At Providence, our strength lies in Our Promise of Know me, care for me, ease my way. We provide best-in-class benefits and an inclusive workplace where diversity is valued. Our 120,000 caregivers serve in over 50 hospitals and 1,000 clinics across multiple states.

Equal Opportunity

Providence is proud to be an Equal Opportunity Employer. We are committed to a workplace free from unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran status, religion, age, national origin, sexual orientation or any other basis prohibited by law. We believe diversity makes us stronger and are dedicated to inclusive opportunities for advancement.