System Manager Claims Healthcare Risk Management
US-CA-GLENDALE
commonspirit_careers
Req #: 458799
Type: Day
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Overview: Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system. Responsibilities: As our System Manager, Claims, you will be responsible for the investigation, evaluation, and disposition of healthcare-related property and/or liability claims and lawsuits that are of a significant and complex nature. You will direct facility professionals on claim investigations that produce accurate facts and lead to timely as well as objective analysis of all assignments. Every day, under limited direction, this position will have high levels of authority to negotiate on behalf of the organization with opposing litigants and attorneys to resolve disputes and lawsuits. You will assist in the coaching, training, and mentoring of other team members and serve as a subject matter expert on specialty claims or risks. To be successful in your role, you will strategically manage complex healthcare claims and litigation, ensuring thorough investigation, objective analysis, and effective resolution. You will demonstrate exceptional expertise in negotiation, risk mitigation, and providing specialized guidance, acting as a pivotal resource for both internal teams and external parties to protect the organization's interests and uphold its reputation. * Settlement authority up to $500,000. * Utilizes best practice claim management techniques and provides high levels of customer service: investigates, evaluates and resolves complex claims and litigation in accordance with CommonSpirit Health Core Values and ERMG policies and procedures. * Conducts full investigations and evaluations on reported claims or suits. Directs MBO professionals and retained legal counsel to develop and implement a focused strategy for timely and cost-effective resolution of complex claims and suits. * Hires, directs, evaluates, and terminates (when appropriate) outside defense counsel. Hiring responsibilities include establishing hourly rates, acceptable use of associates and paralegals, and overall minimum service requirements. * Through claim analysis, assesses economic and non-economic risk to CommonSpirit Health and establishes appropriate financial reserves for budgeting, financial and underwriting reporting. * Coordinates and directs litigation with assigned defense counsel through proper selection, implementing specific action plans to complete case analysis and claim disposition plans. #LI-CSH Qualifications: Required * Ten (10) years of high exposure medical malpractice and general liability claim management experience * Ten (10) years of insurance, legal, health care operations, and medical experience * Healthcare system claim experience Preferred * Bachelor's Degree required - advanced degree preferred, * Insurance or claim-related professional course work, * Employment claim experience in a health care system
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