Sr. Professional Liability Medical Claims Manager *Remote*

Providence

283d • Remote

About The Position

Providence is calling a Sr. Professional Liability Medical Claims Manager who will investigate, evaluate, and manage professional, general, and other liability claims under the PSJH Insurance Program. The role involves communicating with patients, claimants, caregivers, providers, and leadership, reviewing and analyzing medical records, interviewing witnesses, and assisting with the discovery process. The manager will be responsible for writing insurance policy coverage letters, analyzing insurance policy documents, setting appropriate indemnity and expense reserves, and selecting medical experts for case review. Additionally, the manager will develop a plan of action for assigned claims, review and approve statements for services, and inform Senior Manager Operations of large or complex claims. The position requires ensuring compliance with relevant claims reporting procedures and regulations, working with defense attorneys, and maintaining complete documentation for each matter. The manager will also provide input to reduce risk and participate in department projects to improve procedures and policies.

Requirements

• Bachelor's Degree in Business Administration, Finance, or another related field of study or a combination of equivalent education and experience.
• 7+ years of relevant general and professional liability claims processing or management experience.
• 5+ years of direct supervisory or management experience.

Nice To Haves

• Certified Professional Healthcare Risk Management (CPHRM).
• 10+ years of medical malpractice experience.
• Insurance Carrier Experience.
• Third Party Professional Negligence Claims Experience.
• Experience handling Medical Negligence Professional Liability Claims.
• Experience handling Complex General Liability Claims.
• Experience investigating, evaluating, and negotiating medical negligence claims.
• Experience working with defense attorneys specializing in medical negligence claims.
• Experience analyzing medical professional and general liability insurance policy documents.
• Experience writing medical professional and general liability insurance policy coverage letters.
• STARS / Riskonnect or similar claims management software experience.

Responsibilities

• Investigate, evaluate, and manage professional, general, and other liability claims under the PSJH Insurance Program.
• Communicate with patients, claimants, caregivers, providers, and leadership.
• Review and analyze medical records, interview witnesses, and assist with the discovery process.
• Write insurance policy coverage letters and analyze insurance policy documents.
• Set appropriate indemnity and expense reserves.
• Select appropriate medical experts for case review.
• Develop a plan of action for assigned claims and update the claims file.
• Review and approve statements for services and take proper steps to pay vendors.
• Inform Senior Manager Operations of large or complex claims.
• Ensure compliance with relevant claims reporting procedures and required regulations.
• Work with defense attorneys specializing in medical negligence claims.
• Maintain complete documentation for each matter.
• Coordinate with facility leadership, risk managers, and defense counsel.
• Negotiate settlements and monitor trials.
• Participate in department and claims team projects.

Benefits

• 401(k) Savings Plan with employer matching.
• Health care benefits (medical, dental, vision).
• Life insurance.
• Disability insurance.
• Paid parental leave.
• Vacation and holiday time off.
• Voluntary benefits.
• Well-being resources.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Hospitals
• Education Level: Bachelor's degree