Claims Senior Manager

BMC Software•Arlington, MA

About The Position

The Senior Manager Claims, oversees the investigation, evaluation, negotiation, and disposition of all professional and general liability claims against Boston Medical Center, its physicians, and employees. This role handles complex, sensitive, and non-routine claims, requiring extensive insurance industry experience, and develops strategies to minimize organizational exposure and ensure adequate reserves. The Senior Manager provides oversight and guidance to claims staff, prepares reports for insurance brokers, reinsurers, auditors, educates hospital personnel, and collaborates with risk management to reduce risk and claims, directly impacting the organization’s financial stability and operational integrity. Position: Claims Senior Manager Department: Insurance Expense Schedule: Full Time ESSENTIAL RESPONSIBILITIES / DUTIES: Coordinate and perform investigations into all professional and general liability claims and suits against Boston Medical Center, its medical staff, and employees. Determine and regularly review loss reserves for each case to ensure adequacy. Investigate claims and lawsuits, including interviewing BMC physicians and employees Select, manage, and direct defense counsel and review counsel bills to ensure alignment with Hospital objectives. Work with defense counsel to prepare and answer interrogatories and respond to requests for production of documents from plaintiff’s attorney(s). Monitor trials of cases, and evaluate defense counsel performance. Develop and implement defense strategies with defense counsel, including identifying expert witnesses and evaluating their opinions on potential liability. Report all settlements as required to state and federal agencies as required. Evaluate and resolve claims and lawsuits, including direct negotiation with plaintiff counsel and reporting settlements to state and federal agencies as required by law. Prepare and maintain claims data and reports for reinsurers, insurance brokers, auditors, and the Hospital Claims Committee; ensure accuracy to prevent insurance denials. Provide education and guidance to hospital staff and physicians on claims and litigation processes, and mentor Claims Department team members to ensure operational effectiveness. Participate in hospital-wide risk management, patient safety initiatives, and policy development, collaborating with senior administration and department chiefs to reduce organizational exposure. Maintains knowledge of industry standards and practices. Performs other duties as required. (The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required) JOB REQUIREMENTS REQUIRED EDUCATION AND EXPERIENCE: Bachelor's Degree and a minimum of 7–10 years of professional experience in claims management, risk management, or the insurance industry, including experience handling complex or high-value professional and general liability claims; or equivalent combination of education and experience. Experience handling high-exposure, litigated claims. PREFERRED EDUCATION AND EXPERIENCE (If none, please enter “N/A”): Master's and/or Law Degree An advanced degree in medicine or law is preferred. CERTIFICATIONS, LICENSES, REGISTRATIONS REQUIRED (If none, please enter “N/A”): N/A CERTIFICATIONS, LICENSES, REGISTRATIONS PREFERRED (If none, please enter “N/A”): N/A KNOWLEDGE, SKILLS & ABILITIES (KSAs) (If none, please enter “N/A”): Excellent written and oral communication to convey complex information clearly. Ability to gather, interpret, and analyze data to make informed decisions. Skilled in conducting individual and group interviews and using data collection techniques effectively. Ability to negotiate settlements and manage legal and risk-related discussions. Proficient with Microsoft Office applications (Word, Excel, PowerPoint, Outlook) and web-based tools. Compensation Range: $90,500.00- $131,500.00 This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being. NOTE: This range is based on Boston-area data, and is subject to modification based on geographic location. Equal Opportunity Employer/Disabled/Veterans According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not ask or require downloads of any applications, or “apps” job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment. We do not ask individuals to purchase equipment for or prior to employment. Working at Boston Medical Center is more than a job. It’s a chance to make a difference as part of our mission to provide exceptional and equitable care to all. As a nationally-recognized leader in health equity, nursing, initiatives to combat climate change, and many other areas, BMC is dedicated to improving the health of our community in Boston and beyond. BMC’s mission to provide exceptional care without exception extends to our employees, and we have been recognized as a top employer and best place to work. A strong sense of teamwork and support for our staff are the bedrock of BMC, as we know that we can only provide exceptional care to patients when our staff are cared for too. Boston Medical Center is an equal employment/affirmative action employer. We ensure equal employment opportunities for all, without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic. If you need accommodation for any part of the application process because of a medical condition or disability, please send an e-mail to [email protected] or call 617-638-8582 to let us know the nature of your request. Boston Medical Center participates in the Electronic Employment Verification Program. As an E-Verify employer, prospective employees of BMC must complete a background check before beginning their employment at the hospital. BMC requires all staff to be vaccinated against COVID-19 and flu, as well as receive a booster dose of the COVID-19 vaccine. According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not ask or require downloads of any applications, or “apps” job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment. To avoid becoming a victim of an employment offer scam, please follow these tips from the FTC: FTC Tips

Requirements

Bachelor's Degree and a minimum of 7–10 years of professional experience in claims management, risk management, or the insurance industry, including experience handling complex or high-value professional and general liability claims; or equivalent combination of education and experience.
Experience handling high-exposure, litigated claims.
Excellent written and oral communication to convey complex information clearly.
Ability to gather, interpret, and analyze data to make informed decisions.
Skilled in conducting individual and group interviews and using data collection techniques effectively.
Ability to negotiate settlements and manage legal and risk-related discussions.
Proficient with Microsoft Office applications (Word, Excel, PowerPoint, Outlook) and web-based tools.

Nice To Haves

Master's and/or Law Degree
An advanced degree in medicine or law is preferred.

Responsibilities

Coordinate and perform investigations into all professional and general liability claims and suits against Boston Medical Center, its medical staff, and employees.
Determine and regularly review loss reserves for each case to ensure adequacy.
Investigate claims and lawsuits, including interviewing BMC physicians and employees
Select, manage, and direct defense counsel and review counsel bills to ensure alignment with Hospital objectives.
Work with defense counsel to prepare and answer interrogatories and respond to requests for production of documents from plaintiff’s attorney(s).
Monitor trials of cases, and evaluate defense counsel performance.
Develop and implement defense strategies with defense counsel, including identifying expert witnesses and evaluating their opinions on potential liability.
Report all settlements as required to state and federal agencies as required.
Evaluate and resolve claims and lawsuits, including direct negotiation with plaintiff counsel and reporting settlements to state and federal agencies as required by law.
Prepare and maintain claims data and reports for reinsurers, insurance brokers, auditors, and the Hospital Claims Committee; ensure accuracy to prevent insurance denials.
Provide education and guidance to hospital staff and physicians on claims and litigation processes, and mentor Claims Department team members to ensure operational effectiveness.
Participate in hospital-wide risk management, patient safety initiatives, and policy development, collaborating with senior administration and department chiefs to reduce organizational exposure.
Maintains knowledge of industry standards and practices.
Performs other duties as required.