Claims Manager

Stanford Health Care • Sacramento, CA

26d • $67 - $88 • Remote

About The Position

Investigates, manages and resolves reported claims and adverse events defined by Risk Management. Requires coordination with internal stakeholders and staff, as well as oversight and management of panel counsel. Internal investigations include review of medical records, interviews with relevant staff, and analysis of liability and case value. Manages claims information in internal database. Assists Sr. Manager-Claims & Litigation in other claims-related projects as requested.

Requirements

• Bachelor’s degree required.
• Five (5) years of progressively responsible and directly-related claim management experience.
• 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 and 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.

Nice To Haves

• Juris Doctor (JD) degree preferred.

Responsibilities

• Manages litigated claims, evaluates applicable insurance coverages such as professional and general liability, retains outside counsel, attends mediation, monitors litigation costs, and oversees decisions regarding discovery, strategy, and ultimate resolution.
• Investigates pre-suit claims, interviews providers, retains consultants when necessary, prepares case reports, communicates with patients and/or families, and directly negotiates settlements when warranted.
• Prepares claims reports and presents high-exposure cases to leadership and stakeholders, including reinsurance partners.
• Maintains accurate defense and indemnity reserves on assigned claims as facts and circumstances evolve over the life of the claim.
• Inputs all work product and case information into the claims database and manages the database for assigned files to ensure that information is accurate and entered in a timely manner.
• Serves as a resource to other member of the Claims team and Risk Management team members on matters that may have the potential to rise to the level of a claim. Assists in handling general claims or risk management issues as necessary.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees