Area Claims Manager

Employment Type: Full time Shift: Day Shift Description: - Responsible for strategizing and implementing a cost effective and successful process to manage Hospital Professional Liability (HPL), General Liability (GL) and Employment Practices Liability (EPL) claims and litigation, and co-manages uninsured litigation across the system. - Designs and directs the claim investigation process; evaluates claim with respect to liability, causation and damages; develops a resolution strategy and fairly and equitably resolves claims and lawsuits. General Management Responsibilities: - Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision and Values of Trinity Health in behaviors, practices, and decisions. - Ensures adherence to Trinity Health Insurance and Risk Management Services (IRMS) Policies and Procedures. - Complies with Best Practice protocol in management of assigned claims. Claim Management Responsibilities: - Reviews new incidents as assigned and opens claims as needed. - Assesses coverage of all potential Trinity Health insured and obtains formal coverage analysis if indicated. - Formulates and implements a thorough investigation plan for each claim. - Evaluates claim with respect to standard of care, liability, causation, and damages. - Considers witness credibility and expert opinions and determines the value of the claim. - Establishes and completes timely review of indemnity and expense reserves - Participates in the management of uninsured litigation across the system, as assigned. - Determines claim resolution strategy (including trial) and obtains required settlement authority per Settlement Authority Matrix. - Adhering to delegated authority limits, negotiates or directs the negotiation of the claims/lawsuit to resolution. - Notifies excess insurer of claims according to established criteria and provides file updates pursuant to reporting guidelines. - Maintains a diary system to monitor all open claims. - Updates claim files per Best Practice Protocol. - Ensures adherence to IRMS Legal Hold policy. - Participates in Regional Claims Review and Large Loss meetings to ensure matters are presented consistent with the applicable policy. - Represents Health Ministry/Trinity Health in participating in case evaluations, settlement conferences, facilitations, mediation, and trials. - Retains approved defense counsel on a per claim basis. - Directs and supervises the work of outside defense counsel pursuant to the litigation protocol. - Reviews and responds to attorney reports and recommendations as appropriate. - Reviews and approves the defense counsel fee and litigation expenses and adherence to preferred vendor use. - Responsible for compliance with Medicare reporting requirements. Other Responsibilities: - Works collaboratively with Loss Control Directors to identify risk management trends, issues, and opportunities. - Keeps IRMS management apprised of significant case developments, as appropriate. - Directs and supervises Claims staff in maintaining and updating Clearsight database. - Ensures adherence to NPDB and State reporting requirements. - Communicates with Health Ministry (HM) Risk Management/Patient Safety colleagues relative to all aspects involving claims management. This includes: - Communication related to new matters, and potential exposure; - Preservation of evidence, documents, electronic data as needed; - Unsupportive reviews, or other significant case development as needed; - Requests for authority and risk modifications as required per procedure; - Adherence to protocols (venue specific) for protected documents involved in litigation. - Serve as liaison for HM senior leadership relative to pending matters and potential exposure. This includes: - Requests for authority per Settlement Authority Matrix; - Provides updates as needed regarding high exposure claims; - Advises as to high profile/media sensitive matters; - Provides comprehensive claims review as requested for RHM senior leadership. - Develops individual goals in conjunction with Claims Department goals. - Attends and participates in regularly scheduled Team and Department meetings. - Reviews monthly ClearSight reports for accuracy, data integrity and reserve assessment. - Participates in IRMS and/or Trinity Health committees as requested by the Director of Liability Claims to provide subject matter expertise. - Maintains awareness of existing and proposed legislation, court decisions and emerging trends in claims litigation specific to the Team’s venue. - Recommends process and/or procedure changes as appropriate. - Maintains a working knowledge of applicable Federal, State, and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior. MINIMUM QUALIFICATIONS: - Bachelor’s degree in a related field, or an equivalent combination of