Claims and Litigations Manager

UNC Health Care Systems • Chapel Hill, NC

38d • Hybrid

About The Position

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve. Summary: Reporting to the Director of Claims & Litigation, the Claims and Litigation Manager is responsible for the investigation of reported claims and the monitoring of incidents that develop into claims against healthcare providers and staff of UNC Health Care System insured by its commercial and self-insurance liability programs. This position handles internal investigation process of claims, including analysis of medical records, interviews with relevant staff and analysis of value of claim. Assists the Director in managing external legal counsel hired to represent liability program insureds and manages the lawsuit through resolution. Attends mediations, negotiates and settles claims and lawsuits within the settlement authority provided. Inputs and manages claims information in the internal database. Assists the Director in other projects related to claims as requested. In addition to professional liability and hospital liability claims, this position also administers general liability, executive liability, employer liability and small claims as needed.

Requirements

• Bachelor's degree in a related field.
• Five (5) years of experience in risk management, paralegal services, or claims settlement work.
• Ability to analyze and develop solutions to complex problems. Ability to apply judgment and informed decisions. Ability to communicate effectively in written and verbal formats including summarizing data, presenting results. Ability to establish and maintain effective working relationships. Ability to work effectively both as a team player and leader. Knowledge of computer systems and software used in functional area. Knowledge of laws pertaining to professional liability, informed consent, malpractice litigation, and other legal issues. Knowledge of local, state and federal regulatory requirement related to the functional area. Knowledge of medical terms, concepts and practice

Responsibilities

• Manages and conducts claims investigations, gathering data from healthcare providers and employees in a timely manner, researching medical records, protocols, laws, policies and procedures governing the alleged claim. Interviews provide employees, patient, patient family members, and others who are involved with the incident and claim. Obtains internal and expert opinion reviews, prepares case files in orderly, thorough manner; maintains accurate documentation.
• Defines issues involved in the case and makes recommendations for settlement strategies. Negotiates and settles medical malpractice claims or otherwise assists in defense of those claims. Gathers information and reviews settlement agreements. Authorizes funding for settlement payments. Manages external legal counsel hired to represent insureds and manages litigation through resolution.
• Attends conferences with attorneys and staff, mediations, and depositions, and arranges meetings, and communicates policies and procedures to all involved in the claims.
• Inputs all claims and incident information into claims database. Follows through on patient complaints and legal/risk management matters that have potential to result in claims. Interacts as requested with internal and external stakeholders on scheduling of depositions, conducting depositions, coordination of discovery (documents for production and responses to interrogatories), and completion of documentation for claims files.
• Plans, develops, and presents educational sessions with insured faculty and staff regarding loss prevention and reduction techniques, insurance coverages and exclusions, medical record documentation, legal issues and communication techniques. Provides risk management advice to staff regarding incidents that have occurred or issues that are anticipated.
• Assists the Director in evaluating claim exposure, preparation of summaries and other risk management reports, and the development of claims and risk management policies and procedures.

What This Job Offers

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