Senior Risk Manager / Claims Manager - Hybrid

Surgery Partners Careers•Nashville, TN

8d•Hybrid

About The Position

This is a hybrid position based at our beautiful corporate office located in Brentwood, TN, with on-site work required Monday through Wednesday. The Senior Claims Manager ensures disciplined, timely, and consistent handling of every claim by serving as the centralized point of contact for all malpractice matters—from intake through closure. They manage all insurer communications, update claims every 30 days with status summaries, legal counsel reports, and next steps, and ensure complete and accurate documentation. The role involves completing and maintaining a claim evaluation checklist for every claim, including settlement value range, reserve adequacy, jury verdict research, likelihood of defense success, and deductible/retention status. This allows for predictable financial control and clear, data-driven positions to insurers and counsel. The Senior Claims Manager oversees the strategic trajectory of each claim, collecting and analyzing medical records, sequestering medical equipment and records, monitoring and challenging litigation strategies, and documenting all investigatory steps. This ensures proactive case management for better outcomes and reduced expense burn. The role supports Centers and the Enterprise by providing high-level claims handling expertise, real-time risk trend analysis, and informed recommendations. This includes guiding Centers through the claims process, providing insight into claim effects on exposure, reserves, and premiums, educating leadership teams on litigation trends, and serving as a resource for clinical, HR, and legal leaders during adverse events. A critical function is generating analytical reporting and trend evaluation to proactively reduce future losses and insurance costs, identifying systemic patterns, providing actionable recommendations, and developing strategies to reduce ALAE. This supports the insurance renewal process by demonstrating strong internal controls. For significant claims, a post-mortem review is conducted to assess what went wrong, contributing factors, potential for early resolution, and corrective actions to prevent recurrence. Findings are shared with leadership for informed decision-making and long-term risk reduction.

Requirements

5-10 years of experience in medical malpractice claims (with either healthcare risk management or insurance carrier), or self-insured public health care company
Bachelor's degree in nursing, business, finance and/or economics preferred or equivalent work experience
Proficiency in insurance claims management software and systems
Familiarity with Microsoft Office Suite (Excel, Word, Outlook) and other productivity tools.
Detail Oriented - Capable of carrying out a given task with all necessary details to get the task done well
Team Player - Works well as a member of a group
Self-Starter - Inspired to perform without outside help
Excellent communication skills and ability to take a global approach to resolving difficult situations.
Understanding of financial implications to a company for losses and claims
Partnering with carriers and/or third-party claims administrator, counsel, and operators for loss prevention and claims management

Responsibilities

Serve as the centralized point of contact for all malpractice matters—from intake through closure.
Manage all insurer communications, including first notice reporting, large loss notifications, and reserve recommendations.
Update each claim every 30 days with status summaries, legal counsel reports, and next steps and expected timelines.
Ensure complete and accurate documentation to support both defense efforts and insurance carrier expectations.
Complete and maintain a claim evaluation checklist for every claim, addressing settlement value range, reserve adequacy, jury verdict research, likelihood of defense success, relationship/employment status of co-defendants, and deductible/annual retention remaining.
Oversee the strategic trajectory of each claim, including collecting and analyzing medical records, treatment details, statements, and internal documents.
Sequester medical equipment and records as needed.
Monitor and challenge litigation strategies to ensure alignment with corporate risk and financial objectives.
Document all investigatory steps, coverage analysis, settlement positions, and final resolutions.
Guide Centers through the claims process and required documentation.
Provide insight into how each claim affects exposure, reserves, and future premiums.
Educate leadership teams on emerging litigation trends and best practices.
Serve as a resource for clinical, HR, and legal leaders when adverse events arise.
Generate analytical reporting and trend evaluation to proactively reduce future losses and insurance costs.
Identify systemic patterns in claims (procedure type, provider involvement, documentation gaps, etc.).
Provide actionable recommendations to reduce future claims exposure and improve clinical processes.
Develop strategies to reduce ALAE (Allocated Loss Adjustment Expenses) through early intervention, negotiation positioning, mediation strategy, and creative settlement approaches.
Support the insurance renewal process by demonstrating strong internal controls and documented oversight.
Conduct a post-mortem review for every significant claim that is settled to assess what went wrong, contributing factors, potential for early resolution, and corrective actions to prevent recurrence.