Claims Services Consultant

Carilion Clinic•Roanoke, VA

2d•Onsite

About The Position

Assists the Director of Claims at Carilion Clinic with the litigation management process for professional and general liability claims. Collaborates with Claims Specialist on the attorney assist process for Carilion. Produces the loss-run and claims management letters on behalf of BRIC insured providers. Assists with BRIC audit process to ensure compliance with regulatory and governmental requirements. The Claims Services Consultant functions as a resource to claims specialists within the department, while managing 50-60% of open claims, independently, as directed by Director of Claims Management. Consults with and gathers information for outside council, providers, employees, and others involved in malpractice filings or insurance investigations or claims history. Communicate receipt of malpractice lawsuit filing or service, notice of potential compensatory event via notification from event reporting system, risk managers, department heads or physicians, or notification from attorney of representation of plaintiff. Communicate with outside attorneys who are providing legal defense to Carilion and its employees Conduct an investigation, at the direction of defense attorneys, and report findings back to defense Counsel and Director of Claims management. Collect pertinent documents, information and records for litigation as directed by defense counsel. Coordinate meetings with defense counsel and Carilion providers and employees Coordinate and attend meetings to prepare Carilion employees and providers for depositions. Attend depositions and legal hearings. Communicate with the Director of Claims Management pertinent case information and litigation milestones Oversees the attorney assist process to ensure compliance with HIPPA and legal requirements. Ensures that appropriate documentation is executed prior to engaging counsel. Assists Dir. of Claims in responding to audit requests to ensure regulatory compliance. Performs trend analysis on claims data as directed by the Dir. of claims management. Reports this data out at various committees and escalates patterns and concerns to the Dir, of Claims management. Oversees and Manages requests regarding insurance verification and claims history information for appointment and reappointment process for: All current or previously employed physicians All current or previously employed residents All current or previously employed mid-level providers

Requirements

Registered Nurse (BSN) or bachelors degree in health science or Paralegal.
Minimum three to five years experience required in field.
Excellent written and verbal communication skills, with appropriate use of grammar, spelling and/or punctuation.
Knowledge of office procedures and equipment.
Must have strong organizational skills and be self-motivated.
Must be proficient with Microsoft Office Suite including Word, Excel, PowerPoint, Risk Master, and Epic.
Must be able to deal with patients, attorneys, and employees at all levels in a diplomatic manner.

Nice To Haves

Experience in medical malpractice, healthcare, or the legal field preferred.
Advanced education in the field of Risk management or claims management strongly prefered.

Responsibilities

Assists the Director of Claims at Carilion Clinic with the litigation management process for professional and general liability claims.
Collaborates with Claims Specialist on the attorney assist process for Carilion.
Produces the loss-run and claims management letters on behalf of BRIC insured providers.
Assists with BRIC audit process to ensure compliance with regulatory and governmental requirements.
Functions as a resource to claims specialists within the department, while managing 50-60% of open claims, independently, as directed by Director of Claims Management.
Consults with and gathers information for outside council, providers, employees, and others involved in malpractice filings or insurance investigations or claims history.
Communicate receipt of malpractice lawsuit filing or service, notice of potential compensatory event via notification from event reporting system, risk managers, department heads or physicians, or notification from attorney of representation of plaintiff.
Communicate with outside attorneys who are providing legal defense to Carilion and its employees
Conduct an investigation, at the direction of defense attorneys, and report findings back to defense Counsel and Director of Claims management.
Collect pertinent documents, information and records for litigation as directed by defense counsel.
Coordinate meetings with defense counsel and Carilion providers and employees
Coordinate and attend meetings to prepare Carilion employees and providers for depositions.
Attend depositions and legal hearings.
Communicate with the Director of Claims Management pertinent case information and litigation milestones
Oversees the attorney assist process to ensure compliance with HIPPA and legal requirements.
Ensures that appropriate documentation is executed prior to engaging counsel.
Assists Dir. of Claims in responding to audit requests to ensure regulatory compliance.
Performs trend analysis on claims data as directed by the Dir. of claims management.
Reports this data out at various committees and escalates patterns and concerns to the Dir, of Claims management.
Oversees and Manages requests regarding insurance verification and claims history information for appointment and reappointment process for: All current or previously employed physicians All current or previously employed residents All current or previously employed mid-level providers