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System Director Of Claims, Risk Management & Insurance/associate General Counsel
Refer job# PQFO145897
System Director of Claims, Risk Management & Insurance/Associate General Counsel Duties: Direct, plan and manage professional and general liability and workers compensation claims asserted against. This includes lawsuits, attorney s liens and claims for compensation from patients and/or their families as well as employees of the health system and its affiliates. Interfaces with all levels of personnel in the hospitals and clinics as necessary in the performance of the responsibilities of the position. Responsible for the management of professional/ general liability and workers compensation litigation. Selects and assigns cases to defense counsel based on the allegations contained in the complaint and the attorneys experience and expertise in the particular field. Develops and / or implements programs designed to limit liability exposure to the hospital(s) and clinics Negotiates the favorable settlement of claims. Acts as the liaison to legal counsel for evaluating legal claims against the hospital(s) and clinics. Assists in establishing reserves for claims against the hospital(s) Determines and recommends reserve levels for claims covered under Self-Funded Trust Programs in an effort to have adequate financial coverage to support the resolution of asserted claims. Reports regarding claims experience to different levels of clinical and administrative leadership and the Board Advises the third party administrator of new cases and requests the appropriate carriers be put on notice of the new claim and set initial reserves. Keeps abreast of national trends and legal developments so that such information can be used in determining system priorities as they pertain to Claims and Litigation. Actively participates in the defense of cases through completion of written discovery including interrogatories and production requests and oral discovery in scheduling and preparing witnesses for deposition. Plans, coordinates and supervises the activities of Claims department staff. Conducts bi-annual Bordereau meetings with law firms to assess and value claims for risk financing and reserve purposes and report to senior leadership on the severity of cases as they develop over time. Represents the involved entity in any mediation, settlement conference or trial. Actively participates in settlement negotiations within established line of authority. In the claims administration function of the Worker s Compensation Program in conjunction with the Human Resources Department Responsible for the review and approval of all invoices received related to any of the activities of the department including attorney invoices, expert witness fees, production of record requests, and funding worker s compensation program. Ensures that the System s Claims Administration Guidelines as followed.

Qualifications: Bachelor degree. MS degree in Nursing, Business Administration, Hospital Administration, law or a closely related field preferred. 10+ years' experience managing professional and general liability claims is required. Prior experience must include negotiation of settlements and projection of financial serves. Experience in collecting managing, and analyzing health care related data. Experience in utilizing data for continuous quality improvement. Excellent writing and interpersonal skills. Supervisory skills. Budged projections. Interviewing skills. Skills to deal with developing of personnel practices, light bookkeeping, payroll practices, billing/collection, insurance claims and correspondence. Excellent computer literacy with significant experience in word processing, spreadsheet database and graphic programs. Experience with statistical software (SPSS, SAS) is desired.
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