(REMOTE) Area Claims Manager

Trinity Health • Maywood, IL

1d • Remote

About The Position

The Area Claims Manager is responsible for strategizing and implementing a cost-effective process to manage Hospital Professional Liability (HPL), General Liability (GL), and Employment Practices Liability (EPL) claims and litigation, and co-managing uninsured litigation across the system. The role designs and directs claim investigations, evaluates liability, causation, and damages, develops resolution strategies, and fairly and equitably resolves claims and lawsuits. The position operates remotely and may require travel to Trinity Health sites and other locations.

Requirements

• Bachelor’s degree in a related field, or an equivalent combination of education and experience.
• Three to five years of experience as a liability claims professional adjuster, defense malpractice attorney, or hospital risk manager.
• Working knowledge of medical terminology.
• Proficiency in the use of the IRMS claim database (ClearSight).
• Strong analytical skills and ability to organize and communicate information orally and in writing with all levels of the organization.
• Initiative and ability to handle responsibility independently.
• Ability to meet deadlines, respond to shifting priorities, adapt to frequently changing work priorities, and work under pressure.
• Ability to work in a collaborative, shared-leadership environment.
• Personal presence characterized by honesty, integrity, and caring, with the ability to inspire and motivate others in support of Trinity Health’s philosophy, mission, vision, goals, and values.
• Ability to travel to various Trinity Health sites and other locations up to 50% of the time.
• Ability to work independently at a remote location.
• Ability to perform moderate physical activity, including lifting and bending.

Nice To Haves

• 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

• Demonstrate Trinity Health’s Mission, Vision, and Values in behaviors, practices, and decisions, and adhere to IRMS policies and procedures and claims best-practice protocols.
• Review assigned incidents, open claims as needed, assess insurance coverage, and obtain formal coverage analysis when indicated.
• Develop and implement thorough investigation plans; assess standard of care, liability, causation, damages, witness credibility, and expert opinions; and determine claim value.
• Establish and timely review indemnity and expense reserves.
• Participate in managing uninsured litigation across the system as assigned.
• Determine claim resolution strategies, including trial, obtain settlement authority as required, and negotiate or direct negotiations within delegated authority limits.
• Notify excess insurers according to established criteria and provide file updates according to reporting guidelines.
• Maintain a diary system for open claims and update claim files in accordance with best-practice protocols and the IRMS Legal Hold policy.
• Participate in Regional Claims Review and Large Loss meetings and present matters in accordance with applicable policy.
• Represent Health Ministry/Trinity Health in case evaluations, settlement conferences, facilitations, mediation, and trials.
• Retain approved defense counsel; direct and supervise outside defense counsel; review attorney reports and recommendations; and approve defense fees and litigation expenses while ensuring preferred-vendor use.
• Ensure compliance with Medicare reporting requirements, NPDB requirements, and state reporting requirements.
• Collaborate with Loss Control Directors to identify risk management trends, issues, and opportunities, and keep IRMS management apprised of significant case developments.
• Direct and supervise Claims staff in maintaining and updating the ClearSight database; review monthly ClearSight reports for accuracy, data integrity, and reserve assessment.
• Communicate with Health Ministry Risk Management/Patient Safety colleagues about new matters, potential exposure, evidence preservation, significant developments, authority requests, risk modifications, and protected-document protocols.
• Serve as liaison to Health Ministry senior leadership regarding pending matters and potential exposure, including authority requests, high-exposure claims, media-sensitive matters, and comprehensive claims reviews as requested.
• Develop individual goals aligned with Claims Department goals; attend and participate in team and department meetings; and participate in IRMS or Trinity Health committees as requested by the Director of Liability Claims.
• Maintain awareness of relevant legislation, court decisions, and emerging claims-litigation trends; recommend process or procedure changes as appropriate.
• Maintain working knowledge of applicable laws, regulations, the Trinity Health Integrity and Compliance Program, Code of Conduct, and other policies and procedures.
• Travel to Trinity Health sites and other locations as needed, up to 50% of the time, and work independently at a remote location.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager