(REMOTE) Area Claims Manager

Trinity Health•Livonia, MI

2d•Remote

About The Position

This position is for an Area Claims Manager at Trinity Health, one of the largest not-for-profit, faith-based health care systems in the nation. The role involves managing liability claims, ensuring adherence to Trinity Health Insurance and Risk Management Services (IRMS) Policies and Procedures, and complying with Best Practice protocol. The manager will be responsible for reviewing new incidents, assessing coverage, formulating investigation plans, evaluating claims, establishing reserves, determining resolution strategies, and negotiating settlements. The role also includes collaborating with Loss Control Directors, supervising Claims staff, ensuring compliance with reporting requirements, and serving as a liaison for Health Ministry senior leadership. The position allows for remote work.

Requirements

Bachelor’s degree in a related field, or an equivalent combination of education and experience.
Three (3) to five (5) years of experience as a liability claims professional adjuster, defense malpractice attorney or hospital risk manager.
Proficiency in the use of IRMS claim database (Clearsight).
Working knowledge of medical terminology.
Strong analytical skills.
Ability to organize and communicate information both orally and in writing with all levels of the organization.
Initiative and the ability to handle responsibility independently.
Ability to meet deadlines and respond to shifting priorities.
Comfortable operating in a collaborative, shared leadership environment.
A personal presence which is characterized by a sense of honesty, integrity and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.
Ability to travel to the various Trinity Health sites if/when needed.
Ability to work independently at a remote location.
Ability to adapt to frequently changing work priorities as well as work under pressure.
Ability to perform moderate physical activity, lifting and bending.

Nice To Haves

A clinical health care degree and/or graduate degree in law or hospital administration.
Supervisory experience.
Advanced knowledge and working relationships in risk management, quality management and improvement.

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.
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.
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.
Serve as liaison for HM senior leadership relative to pending matters and potential exposure.
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.