Working with minimal supervision, this position proactively and effectively manages and resolves complex liability (with emphasis on Hospital Professional Liability) and/or property claims. This position is responsible for building and maintaining working relationships with defense counsel, claimants and their attorneys, internal staff and MBO risk management staff.
Proactive investigation, evaluation, strategy development, management and resolution of claims.
Directs and collaborates with defense counsel for effective management of litigated claims while controlling defense costs.
Applies legal and medical principles and statutes to claim facts and allegations in order to determine compensability.
Applies insurance policy language to determine coverage and identify issues.
Negotiates fair compensation settlements up to authorized authority levels while conserving the assets of CHI.
Establishes reserves following CHI’s policies and philosophies.
Manages and directs the use of outside vendors and retained experts.
Works with MBO Representatives to manage claims and communicate plan of action and exposure assessments to MBO management.
Pursues subrogation and excess recovery opportunities.
Maintains the integrity of data in claim system and hard files.
Attends liability trials to provide on-going status, assessments, and recommendations to Risk & Insurance Management staff and MBO management.
Identifies loss prevention opportunities and communicates these to MBO and Risk & Insurance Management staff.
Handles claims in compliance with state insurance regulations including fair claims handling practices.
Actively mentors less experienced claim staff
Bachelor's degree or equivalent education and/or experience required.
A minimum of 5 years experience adjusting claims in the specific line of coverage (workers compensation or hospital professional liability) including a significant volume of litigated claims with demonstrated high performance and the ability to work independently.
Industry education such as: ARM, AIC, CPCU preferred.
Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times.
Adheres to and exhibits our core values:
Having a profound spirit of awe and respect for all creation, shaping relationships to self, to one another and to God and acknowledging that we hold in trust all that has been given to us.
Moral wholeness, soundness, uprightness, honesty and sincerity as a basis of trustworthiness.
Feeling with others, being one with others in their sorrows and joys, rooted in the sense of solidarity as members of the human community.
Outstanding achievement, merit, virtue; continually surpassing standards to achieve/maintain quality.
Maintains confidentiality and protects sensitive data at all times.
Adheres to organizational and department specific safety standards and guidelines.
Works collaboratively and supports efforts of team members.
Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community.
Catholic Health Initiatives and its organizations are Equal Opportunity Employers. CB
Scheduled Hours per 2-week Pay Period
Catholic Health Initiatives - 18 months ago
For Catholic Health Initiatives (CHI), returning sick people to good health is more than a business -- it's a mission. Formed in 1996...