Claims Analyst or (Senior) Claims & Patient Safety Specialist

MIEC•Oakland, CA

1d•Remote

About The Position

MIEC is seeking a dynamic claims professional to join their team. This role involves protecting medical professionals and advancing patient safety. Depending on experience, candidates may be considered for Claims Analyst, Claims and Patient Safety Specialist, or Senior Claims and Patient Safety Specialist. Responsibilities include opening, investigating, managing, and resolving incident and claim files. Specialist roles will have expanded patient safety, risk management, and leadership responsibilities. The role also involves partnering with policyholders to deliver Patient Safety & Risk Management services, aiming to shape safer healthcare environments and become a trusted advisor. The position is remote, with a preference for candidates in Southern California or adjacent states, requiring limited travel to the Oakland, CA office and occasional overnight stays. The hiring salary range is $73,050 to $156,958, based on role, experience, and location, with specific ranges provided for different roles and locations (San Francisco Bay Area/Hawaii vs. all other locations).

Requirements

Demonstrated expertise in the handling of medical professional liability claims.
Solid understanding of Patient Safety Risk Management (PSRM) services and products.
Ability to address general PSRM questions or refer to the appropriate discipline.
Flexible collaborator with a demonstrated customer service focus with all levels of internal and external stakeholders.
Enthusiastic and self-directed contributor skilled at managing multiple priorities with great attention to detail, within time-sensitive deadlines.
Inquisitive analytical thinker with good judgment, professional initiative, and strong research skills.
Excellent communicator, with strong written, verbal, and interpersonal communication skills.
Proficiency in medical terminology is ideal.
An understanding of clinical systems (for Claims & Patient Safety Specialist role).
Knowledge of hospital policies and procedures, and governmental healthcare regulations (for Claims & Patient Safety Specialist role).
Ability to analyze medical records and quality issues (for Claims & Patient Safety Specialist role).
Advanced claim judgment (for Senior Claims & Patient Safety Specialist role).
Ability to manage complex matters with limited oversight (for Senior Claims & Patient Safety Specialist role).
Readiness to serve as a technical resource for others (for Senior Claims & Patient Safety Specialist role).
A Bachelor’s degree (BA/BS) is required.
A valid driver’s license is required.
Minimum of five (5) years of experience handling medical professional liability claims or professional-level experience in the legal industry (for Claims Analyst).
Minimum of seven (7) years of experience as a medical professional liability claims representative, healthcare risk manager or similar experience in defense of medical professional liability or risk management/patient safety field (for Claims & Patient Safety Specialist).
Minimum of ten (10) years of experience as a medical professional liability claims representative, healthcare risk manager or in a similar role involving the defense of medical professional liability matters or risk management/patient safety work (for Senior Claims & Patient Safety Specialist).
Senior-level candidates should also demonstrate experience handling complex claims or risk matters, exercising independent judgment, advising stakeholders, and contributing to team knowledge or process improvement.
Digitally fluent contributor, comfortable in a range of virtual environments.
Proficient with office software including Word, Excel, Power Point, Windows, Teams, Sharepoint, CoPilot, and paperless document management programs.

Nice To Haves

A Certified Professional in Healthcare Risk Management (CPHRM) designation is preferred.

Responsibilities

Respond to first notice of potential claims from policyholders and handle advice calls, gathering preliminary information and providing appropriate advice for action.
Collaborate with the Claims team to identify and evaluate insurance coverage issues, and to develop, prepare and implement appropriate negotiation/case resolution strategies.
Obtain and review records, interrogatories, depositions, consultant reports, and attorney reports; coordinate discovery with defense counsel; monitor file status, reserves, legal landmarks and billings.
Prepare documentation, reports, and correspondence with policyholders, claimants and attorneys.
Submit incident, claim and suit files for opening; manage and close files in a timely manner.
Exercise strong judgment in settling cases within authority and develop indemnity and expense reserve recommendations above defined authority level.
Study trends and current developments within the medical malpractice industry in the states in which MIEC operates, and nationally.
Proactively share information within the department about the trends and current developments, including relevant court cases.
Participate in seminars, trainings, meetings, and Board meetings, when requested.
Collaborate with MIEC’s Patient Safety & Risk Management (PSRM) staff to provide specialized internal and external services addressing existing member groups and new business, including large medical groups and hospitals (for Specialist roles).
Apply principles of healthcare risk management, such as incident reporting and investigation, risk analyses, and policies/procedures, to further develop PSRM services which can be applied in all healthcare settings (for Specialist roles).
Collect, analyze, and compare MIEC data to present evidence-based information to members, utilizing data from various healthcare and medical malpractice claims sources including Candello - Solutions by CRICO, the MPL Association Data Sharing Project, and Preverity (for Specialist roles).
Coordinate and conduct Claims Prevention Surveys for policyholders (for Specialist roles).
Manage active matters involving unanticipated patient harm through MIEC’s RESTORE communication and resolution program; work with MIEC policyholders to support effective patient communication, disclosure, and/or apology discussions (for Specialist roles).
Effectively research, write, and edit patient safety and risk management articles, newsletters, and other written materials (for Specialist roles).
Participate in the conception and completion of special projects (for Specialist roles).
Handle higher-complexity claims and patient safety matters (for Senior Specialist role).
Serve as a senior resource for claim strategy and coverage evaluation (for Senior Specialist role).
Support consistent file handling practices across the team, and Help mentor less-experienced claims staff through case consultation, technical guidance, and knowledge sharing (for Senior Specialist role).
Lead or support higher-level patient safety and risk management engagements, including complex policyholder consultations, claims prevention initiatives, data-informed presentations, and cross-functional projects that require advanced judgment, independent analysis, and strong facilitation skills (for Senior Specialist role).