Claims Manager: Remote

Medstar Research Institute
Columbia, MD
Jul 30, 2021
Aug 04, 2021
Full Time
Job Summary Responsible within an assigned portion of the MedStar system for managing all aspects of professional liability, general liability and workers compensation claims management. In addition each claims manager is responsible for fully supporting MedStar#s risk financing program, particularly its captive insurance program(GFIL), as well as MedStar#s patient safety and loss prevention programs. The strategic importance of this position is to manage the entire claims process to support a best in class risk management and loss prevention system. Reporting directly to the Vice President for Risk Management Services with matrix reporting to MedStar#s Chief Medical Officer, the Claims Manager has matrix responsibility for the eight hospital risk managers/directors as well as the eight hospital occupational health managers. Minimum Qualifications Education/Training Bachelor#s degree; JD, advanced degree or clinical training preferred. # Experience 5 years professional and general liability claims/litigation management experience. # License/Certification/Registration Professional insurance designations preferred. # Knowledge, Skills # Abilities Excellent oral and written communication skills, including presentation presence. Ability to make complex decisions, quickly identifies, analyzes and evaluates problems and recommends solutions. Solid judgment, conceptual and anticipatory skills with a proven ability to think outside the box and be flexible in order to meet business challenges. Unquestioned integrity and ethics, as well as accountability for results. Primary Duties and Responsibilities Develops and contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Ensures compliance with hospital/facility policies and procedures and governmental/accreditation regulations. Develops and disseminates information reports across the system that reflect major issues, trends, and information which supports individual hospital efforts to reduce risk; develops communication programs and educational efforts for clinical professionals and hospital staff to support efforts. Develops and maintains ongoing positive relationships with insurers, attorneys, mediators, legislators, State Compensation Board, and other constituents; takes a leadership role in broader tort reform efforts both locally and nationally. Maintains a strong positive matrix reporting relationship with the site-based risk managers to insure that all: (1)incidents that have the potential to result in claims of liability are identified, investigated and reported in a timely manner; (2) professional liability claims and suits are responded to in a timely and appropriate manner; (3) events that result in liability are thoroughly reviewed to determine if loss prevention actions are necessary to avoid similar claims of liability in the future; (4) the hospital/business unit leadership are kept appropriately informed regarding the status of any claims that relate to that hospital/business unit; and (5) claims and suits are managed to a successful conclusion. Maintains a strong positive working relationship with all other MedStar Risk Management Program personnel, including the system vice president of Risk Management and the Insurance Manager. Manages all aspects of claims management activities as they financially impact MedStar#s captive insurance company, Greenspring Financial Insurance Limited (GFIL) including, but not limited to, maintaining a sound claims reserving program that insures that MedStar#s liability exposure related to these claims is timely and adequately recognized and recorded. Operates a claims management program for the MedStar system, which is oriented to loss prevention and incorporates a broader platform in claims, risk management, patient safety and quality of care data that is integrated and provides information and direction for minimization of claims and improvement in patient safety and quality of care. Oversees the Third Party Administrator (TPA) retained by MedStar to administer its workers compensation claims management program in a timely manner. Performs other duties as assigned. Provides full support to the efforts within MedStar to prevent avoidable injury to patients, staff, employees and visitors including establishing within every claims management program (especially the medical professional, general liability and works compensation claims programs) and system that communicates in a most timely fashion to the appropriate MedStar representative any loss prevention, error prevention or injury prevention #lessons learned# as the result of the review and investigation into the events or circumstances of any claim under management. Provides leadership within the MedStar system for all aspects of identification, management and successful resolution of claims involving medical professional liability and corporate general liability. Provides overall support to the MedStar insurance managers for any claims relating to MedStar#s property insurance, automobile insurance or other casualty or liability insurance in place to protect the interests of MedStar. Provides strong visible leadership within the MedStar community regarding claims management and claims prevention. Provides support to the VP Risk Management to ensure that MedStar#s captive insurance company (GFIL) and its DC domiciled Risk Retention Group operate effectively to support the individuals and programs for which they provide liability coverage. Represents MedStar Health in a most positive manner to all those outside of MedStar, including its patients and their families, physicians, nurses, the business and legal community and the community at large. Works closely with the MedStar VP, Risk Management to manage all financial aspects of the MedStar workers compensation claims program including, but not limited to, establishing and maintaining a sound claims reserving program that insures that MedStar#s workers compensation liability exposure is timely and adequately recognized and recorded.#06022021