Claims Manager

Boston Medical Center•Boston, MA

39d

About The Position

The Claims Manager is responsible for the management of claims and litigation which include coordinating insurance coverage, managing claims against BMC, interfacing with defense legal counsel, managing and analyzing claims data, collaborating with risk management with the objective of controlling and minimizing losses to protect BMC's assets.

Requirements

Bachelor's Degree
Relevant claims management experience required.
Ability to effectively conduct interviews and utilize a variety of data collection and analysis techniques to inform decision-making.
Skill in managing multiple projects simultaneously, prioritizing tasks, and meeting established deadlines.
Ability to write clearly, concisely, and professionally for diverse audiences.
Strong presentation skills, including the ability to speak confidently to large audiences and develop effective visual presentations (e.g., PowerPoint).
Ability to interact effectively with a broad range of hospital executives, staff, and physicians, fostering collaboration and professional relationships.
Ability to develop and implement risk management policies and procedures to ensure an effective Risk Management Program.

Nice To Haves

Registered Nurse or Law Degree. Without a RN or Law Degree, a minimum of 1-2 years of clinical experience is required.

Responsibilities

Collaborates with the Senior Director of Insurance and Claims to develop, implement, and update policies and procedures that minimize loss exposure and support effective claims resolution.
Communicates and promotes risk management policies and practices across the organization by developing and delivering educational programs for BMC staff and physicians at the general direction of the Senior Director of Insurance and Claims.
Review and analyze existing policies for coverage and exclusion clauses.
Manages and maintains insurance coverage for BMC's deductible/self-insurance program, residents, and attending physicians.
Oversee the investigation and documentation of incidents and claims, ensuring timely reporting, collection of relevant information, and coordination with insurance carriers and defense counsel to support claim defense and resolution.
Prepares and presents regular reports on claims management activities and emerging risk trends for the General Counsel, Hospital Claims Committee, and other designated leaders.
Provides guidance on insurance policy provisions and reserve funding levels for both insured and self-insured programs, in collaboration with the General Counsel, to ensure appropriate financial planning and risk mitigation.
Maintains legal case files and claim documentation to ensure compliance, confidentiality, and protection from discoverability, and tracks key reporting and action dates to support timely follow-up.
Advises leadership on insurance coverage, claim reserves, and risk exposure in collaboration with the General Counsel and actuarial partners, providing data and analysis to support strategic decision-making.
Partners with Quality Assurance to maintain effective incident reporting and risk screening systems, identifying patterns and opportunities for risk reduction.
Serves as an immediate resource for staff and physicians during adverse events, providing guidance on appropriate next steps and coordination with risk and legal teams.
Notifies the liability insurance carriers of all actual and potential claims, including primary and excess carriers as necessary.
Reviews and investigates all incidents/accidents that could lead to financial loss or injury to patients, visitors, and employees, and ensure that all information necessary to prepare for the defense of claims is collected and properly maintained.
Collaborates with defense counsel to develop defense strategy or settlement values to minimize Hospital exposure/settlement payments.
Monitors defense counsel activities to help drive matters toward resolution.
Record, collect, document, maintain, and communicate to the insurance carriers and/or attorney any information necessary to prepare testimony in pending litigation, including mock trial coordination.
Evaluate correspondence from attorneys, patients, and other outside sources and formulate responses as necessary.