(REMOTE) Claims Specialist

Trinity Health•Livonia, MI

1d•$37 - $56•Remote

About The Position

The Claims Specialist investigates, evaluates, and resolves assigned Professional Liability (HPL), General Liability (GL), and Employment Practices Liability (EPL) claims. The role develops investigation plans, assesses standard of care, liability, causation, damages, witness credibility, and expert opinions, determines claim value, and establishes appropriate indemnity and expense reserves. In coordination with defense counsel and the (Senior) Area Claims Manager, the specialist develops and communicates resolution strategies, obtains settlement authority, and negotiates or directs claims and lawsuits to resolution within delegated authority. The position maintains claim files and a diary system, presents claims at internal reviews, represents Trinity Health and its facilities in settlement-related proceedings and trials, and retains and supervises approved outside defense counsel. It also monitors Medicare Secondary Payer compliance, identifies loss-control issues and risk-reduction opportunities, and follows IRMS and Trinity Health policies and procedures. The specialist is expected to demonstrate Trinity Health’s mission, vision, and values and maintain knowledge of applicable laws, regulations, and compliance requirements. The role operates in a typical office environment and requires travel to Trinity Health sites and other related locations up to 50% of the time. The position involves adapting to changing priorities, working under pressure, and performing moderate physical activity, including lifting and bending. Hourly pay range: $37.07–$55.60.

Requirements

Knowledge of professional liability, general liability, and employment practices liability claims management, normally acquired through a bachelor’s degree and experience as a liability claims professional adjuster or hospital risk manager, or an equivalent combination of education and experience.
Working knowledge of medical and/or employment law terminology.
Strong analytical skills.
Ability to organize and communicate information orally and in writing with all levels of the organization.
Initiative and ability to handle responsibility independently.
Ability to meet deadlines and respond to shifting priorities.
Comfort working in a collaborative, shared-leadership environment.
Ability to adapt to frequently changing work priorities and work under pressure.
Ability to perform moderate physical activity, including lifting and bending.
Ability to travel to Trinity Health sites and other related locations up to 50% of the time.
Honesty, integrity, caring, and ability to inspire and motivate others in support of Trinity Health’s philosophy, mission, vision, goals, and values.

Nice To Haves

A clinical health care degree is preferred.
Advanced knowledge and working relationships in risk management, quality management, and improvement are helpful.

Responsibilities

Investigate, evaluate, and resolve assigned HPL, GL, and EPL claims.
Formulate and implement investigation plans; evaluate standard of care, liability, causation, damages, witness credibility, expert opinions, and claim value.
Set appropriate indemnity and expense reserves in a timely manner.
Develop and communicate claim resolution strategies with defense counsel and the (Senior) Area Claims Manager; obtain settlement authority and negotiate or direct negotiations within delegated authority.
Notify excess insurers of selected claims and provide updates according to reporting guidelines.
Maintain a diary system for open claims and update claim files according to documentation guidelines.
Present claim information at internal claim reviews.
Represent facilities and/or Trinity Health at case evaluations, settlement conferences, facilitations, mediations, and trials.
Retain approved defense counsel and direct and supervise outside counsel in accordance with litigation protocols.
Review and respond to attorney reports and recommendations, and review and approve defense counsel fees and litigation expenses.
Keep the (Senior) Area Claims Manager informed of case developments as appropriate.
Monitor compliance with Medicare Secondary Payer requirements, including CMS inquiry responses in Stars, relevant Stars files, lien information, and MSP language in responses and settlement documents.
Identify loss-control issues and make recommendations; document risk-modification and risk-reduction strategies in claim files and STARS.
Collaborate with loss-control directors to identify risk-management trends, issues, and opportunities.
Adhere to IRMS and Trinity Health policies and procedures, applicable laws and regulations, and integrity and compliance requirements.
Demonstrate Trinity Health’s mission, vision, and values in professional behavior and decisions.