Claims Manager

Baystate Health • Springfield, MA

10d • Hybrid

About The Position

The Claims Manager oversees complex, high-exposure self-insured Professional Liability, General Liability, Employment, and Directors and Officers Liability claims, as well as claims and lawsuits insured under the Community Provider Insurance Program. The role investigates claims, manages defense counsel and litigation strategy, negotiates settlements, attends and monitors legal proceedings, and presents claims information to Baystate committees and the Baystate Health Insurance Company Board of Directors.

The Claims Manager partners with Risk Managers and the Communication, Apology, and Resolution (CARe) team to assess and resolve significant unanticipated adverse outcomes of care. The role interacts compassionately and professionally with affected patients and families, reports safety concerns to appropriate departments, and supports system-wide operational and risk-management objectives. The position also contributes to claims education, reporting, mentoring, and regulatory compliance.

This is a full-time, Monday-through-Friday position. A hybrid schedule is available after orientation, with an office location at 280 Chestnut Street.

Requirements

• Bachelor's degree required.
• Seven years of experience managing professional liability claims, including complex cases.
• Familiarity with state and federal laws pertaining to medical professional liability, general liability, and employment practices liability, including Directors and Officers claims.
• Excellent written and oral communication skills, analytical thinking, interpersonal skills, and decision-making ability.
• Strong negotiation skills, including with complex, high-value professional liability claims.
• Experience with mediation and arbitration and knowledge of medical terminology.

Nice To Haves

• Master's degree preferred in Nursing, Risk Management, a healthcare-related field, or a J.D.
• Prior medical malpractice, employment practices liability, or related claims experience.
• Clinical experience.
• Risk management experience.
• Legal experience involving medical malpractice litigation.

Responsibilities

• Investigate assigned claims, lawsuits, and other matters, including reviewing complex medical issues, interviewing medical personnel and staff, and reviewing internal investigations of care issues.
• Gather information efficiently, document investigation activities and results, and maintain claims files and databases as cases develop.
• Evaluate and set claim reserves in accordance with Baystate's reserving philosophy, under the oversight of the Sr. Director of Claims, Litigation and Insurance, and adjust reserves as exposure changes.
• Monitor claims to ensure appropriate case development and pursue resolution when appropriate.
• Select defense counsel from the approved panel or obtain approval from the Sr. Director of Claims, Litigation & Insurance; work with counsel to select expert witnesses and develop and approve defense strategies.
• Oversee defense counsel and litigation, monitor compliance with Litigation Management Guidelines, and review and approve legal invoices for compliance with billing guidelines.
• Attend depositions and monitor trials as a corporate representative; develop trial strategies with defense counsel and recommend high-low agreements when appropriate.
• Negotiate settlements of complex medical malpractice and other assigned claims, discuss potential settlements with management, and use mediation and other legal tools as appropriate.
• Provide reinsurers with requested information, including defense and settlement strategies, litigation status, discovery updates, expert reviews, reserves, and financial exposure.
• Investigate employment and Directors and Officers claims in collaboration with Human Resources; assign and monitor defense counsel and assist with defense strategies.
• Attend MCAD proceedings, depositions, mediations, and trials on behalf of the corporation; negotiate employment claim settlements within Baystate's self-insured retention and work with Baystate's commercial EPL/D&O carrier.
• Establish and maintain processes for CARe and other system-wide initiatives related to the Baystate Health Communication & Resolution Program.
• Investigate adverse patient outcomes that meet CARe criteria with Risk Managers and the CARe Program Manager, determine whether outside expert reviews are needed, and establish plans for further evaluation and analysis.
• Seek prompt and fair resolution of claims when feasible.
• Collect and report claims data to monitor severity and frequency trends, support adequate reserving, and benchmark against the insurance marketplace.
• Mentor claims handlers, CARe managers, and Risk Managers as needed.
• Participate in quarterly regional insurance captive benchmarking meetings.
• Comply with state and federal regulatory reporting requirements, including NPDB, BORM, and MMSEA.
• Partner on CARe cases and interact with patients and families affected by adverse outcomes in a caring and compassionate manner while pursuing ethical, safety, and financial outcomes.
• Collaborate with Risk Managers to report safety concerns to appropriate departments and support operational priorities with executives and senior leaders.
• Educate and present on Risk and Claims Management.

Benefits

• Medical, dental, and vision coverage, including local Health New England plans, depending on eligibility.
• Tuition assistance, CEUs, and professional development opportunities.
• Clinical advancement, leadership development, and internal career opportunities.
• Retirement savings and employer match.
• Generous paid time off for eligible employees.

What This Job Offers

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