General Summary Provides risk management services to System entities. Evaluates the risk of financial or property losses and arranges for appropriate insurance coverage for such losses. Oversees the claims process, including managing activities, documents, and files related to handling and settling claims, as well as ensuring that each claim is handled promptly, appropriately, and in accordance with company policy.
Manages day-to-day operations of claims function and provide general oversight and direction of all litigation and claims activity. Assumes the duties and responsibilities of the Risk Manager in their absence. Duties and Responsibilities
Responds to questions concerning risk management and claims that may arise. Conducts and participates in Root Cause Analyses and risk assessments such as PRAs, FMEAs, etc. upon request and as needed. Participates in the WSH Accreditation/Risk Management on-call rotation.
Reviews event reports daily. As requested, assists the entity patient safety officer in the event of investigation and in decisions concerning regulatory reporting issues. Conducts educational sessions on risk issues for the various entities as necessary.
Investigates allegations of inappropriate treatment/care which results in injury (or alleged injury) to a patient/visitor and determines next steps. Drives proficiencies in claims processes and investigations to reduce litigation costs by tracking, reviewing, and analyzing newly litigated cases. Determines the complexity and value of litigated claims for possible resolution, attending trial as needed.
Reviews and analyzes initial case assessment and legal strategy and assists in the development of litigation strategy. Collaborates with leadership to develop reporting metrics (for example, reporting metrics packet) and develops reports and communicates results of current and potential litigation trends to leadership, including, but not limited to, communicating updates such as pre-trial reminders, daily trial updates, and summaries of cases where an increase in indemnity reserves is being requested, as well as any other critical updates.
Identifies, gathers, and preserves discovery items, or items requested by defense counsel that will assist with an investigation, related to existing or potential litigation. Manages and oversees outside counsel on litigation, discovery matters, litigation costs, negotiations, and settlement agreements by identifying and assigning counsel to handle claims. Reviews and approves outside counsel invoices to ensure billable hours are appropriate for each case and rejects incorrect invoices and follows up with outside counsel when there are questions with respect to such invoices.
Directs the preparation and maintenance of department reports. Prepares periodic reports for top management, as required. Provides management services to the WellSpan reciprocal Risk Retention Group, and coordinates activities of governing board, attorneys, and consultants.
Common Expectations: Maintains established policies and procedures, objectives, quality assessment, and safety standards. Maintains appropriate records, reports, and files as required. Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
Works collaboratively with Risk Management, Accreditation and Licensure, and key stakeholders to address organization risks. Travel
Estimated Amount: - Some travel required within WellSpan Health geographic service area. Qualifications Minimum
Masters Degree Required or Doctor of Law (JD) Required Work
2 years Health care or insurance related experience. Required Claims management or paralegal background experience. Preferred Licenses: Certified Professional in Healthcare Risk Management within 3 years Required and Healthcare Accreditation Certified Professional within 3 years Required or Certified Joint Commission Professional within 3 years Required or Certified Healthcare Operations Professional within 3 years Required Licensed Attorney Upon Hire Preferred Knowledge, Skills, and Abilities: Superior human relations and oral/written communications skills.
Benefits Offered: Comprehensive health benefits Retirement savings plan Paid time off (PTO) Education assistance Financial education and support, including DailyPay Expanded Paid Parental Leave For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org)
Full time · Shift1 - Day shift