Sr. Professional Liability Medical Claims Manager Remote

Providence-posted 9 months ago

Full-time • Senior

Remote • Renton, WA

Hospitals

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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 ensure compliance with relevant claims reporting procedures and required regulations. The position requires fostering teamwork and effective communication within the claims team and maintaining complete documentation for each matter.

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 defense of medical negligence claims.
Maintain complete documentation for each matter.
Coordinate with facility leadership, risk managers, defense counsel, and others.
Negotiate settlements and monitor trials.
Participate in department and claims team projects as assigned.

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.

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 defense of 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.