Senior Claims Manager (Remote) - Professional Liability Program

Washington University in St. Louis • St. Louis, MO

30d • Remote

About The Position

Analyzes and evaluates complex incident reports and lawsuits, reviews medical records and interviews involved individuals to obtain needed information. Prepares complex investigative analytical reports for Director and Legal Counsel regarding potentially compensable incidents covered by the Self-Insured Professional Liability Program, and other reports as requested by Senior Management. Coordinates case development, case management, and participates in office management.

Requirements

• Bachelor's degree
• Analyzing Or Interpreting Medical Or Other Technical Evidence That Compares In Level Of Complexity To Medical Treatment (5 Years)

Nice To Haves

• Analytical ability to evaluate facts and formulate questions in order to define problems and critical events in the medical care rendered.
• General knowledge of The Joint Commission and patient safety standards, diagnosis and treatment of human disease and injury, medical therapies, procedures and standard of medical care.
• Knowledge of methods and techniques of individual case study, recording and file maintenance.
• Seven years’ experience in medical malpractice claims management.
• Analytical Thinking
• Defining Problems
• Detail-Oriented
• Disease Diagnosis
• Disease Management
• Group Presentations
• Injury Treatment
• Joint Commission Regulations
• Organizational Savvy
• Patient Safety
• Report Preparation

Responsibilities

• Conducts internal claims investigations, plans defense strategies and negotiates disposition of assigned files with guidance of legal counsel.
• Conducts meetings with physicians, analyzes medical record information and event reports; directs approved legal counsel and other legal personnel involved in the defense; evaluates liability and financial exposure, approves expert witness reviews; responds to discovery requests and answers interrogatories; coordinates witness preparations; makes recommendations for resolution of claim; and coordinates meetings with Director, defense counsel and Office of General Counsel to perform decision tree analysis to determine case value.
• Attends mediation, arbitration, and/or trial.
• Prepares and submits required reports to Department Heads, Office of General Counsel, Director of Risk Management, excess insurance carriers, and when applicable, coordinates with external agency investigations, i.e., professional Board inquiries.
• Responds to general claim inquiries.
• Establishes indemnity and expense reserves based on the reserving policy.
• Negotiates settlements within authority.
• Reviews and approves defense counsel related invoices and expenses.
• Provides consultation and guidance on healthcare issues such as medical record release, subpoena responses, termination/transfer of care, patient complaints, and physician billing issues including accounts in litigation.
• Arrange for attorneys to attend depositions with physicians when necessary.
• Mentors less experienced claims managers.
• Performs other duties as assigned.

Benefits

• Up to 22 days of vacation, 10 recognized holidays, and sick time.
• Competitive health insurance packages with priority appointments and lower copays/coinsurance.
• Take advantage of our free Metro transit U-Pass for eligible employees.
• WashU provides eligible employees with a defined contribution (403(b)) Retirement Savings Plan, which combines employee contributions and university contributions starting at 7%.
• Wellness challenges, annual health screenings, mental health resources, mindfulness programs and courses, employee assistance program (EAP), financial resources, access to dietitians, and more!
• We offer 4 weeks of caregiver leave to bond with your new child. Family care resources are also available for your continued childcare needs. Need adult care? We’ve got you covered.
• WashU covers the cost of tuition for you and your family, including dependent undergraduate-level college tuition up to 100% at WashU and 40% elsewhere after seven years with us.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees