Claims Analyst or (Senior) Claims & Patient Safety Specialist

MIEC•Oakland, CA

7d•$73,050 - $156,958•Remote

About The Position

MIEC is seeking a dynamic claims professional to join their team, playing a pivotal role in 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. In each role, the individual will be responsible for opening, investigating, managing, and resolving incident and claim files for policyholders. The Specialist and Senior Specialist roles will have expanded responsibilities in patient safety, risk management, and leadership. Beyond claims management, the Analyst or Specialist will partner with groups and individual policyholders to deliver innovative Patient Safety & Risk Management services, helping to shape safer healthcare environments and becoming a trusted advisor.

Requirements

Demonstrated expertise in the handling of medical professional liability claims.
Solid understanding of Patient Safety Risk Management (PSRM) services and products, and the ability to address general PSRM questions or refer to the appropriate discipline.
Demonstrated customer service focus with all levels of internal and external stakeholders.
Skilled at managing multiple priorities with great attention to detail, within time-sensitive deadlines.
Inquisitive analytical thinker with good judgement, 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.
Knowledge of hospital policies and procedures, and governmental healthcare regulations.
Ability to analyze medical records and quality issues.
Advanced claim judgment.
Ability to manage complex matters with limited oversight.
Readiness to serve as a technical resource for others.
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 and proficient with office software including Word, Excel, Power Point, Windows, Teams, Sharepoint, CoPilot, and paperless document management programs.

Nice To Haves

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.
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.
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.
Coordinate and conduct Claims Prevention Surveys for policyholders.
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.
Effectively research, write, and edit patient safety and risk management articles, newsletters, and other written materials.
Participate in the conception and completion of special projects.
Handle higher-complexity claims and patient safety matters.
Serve as a senior resource for claim strategy and coverage evaluation.
Support consistent file handling practices across the team.
Help mentor less-experienced claims staff through case consultation, technical guidance, and knowledge sharing.
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.