Claims Investigator: Liability & Settlements Expert

Trinity Health; United States; Remote; USD 90,000 - 130,000; Full time

Job summary

Trinity Health seeks a skilled claims professional to investigate and resolve professional, general, and employment practices liability claims. You will develop investigation plans, assess liability and damages, and manage settlements with defense counsel.

You will coordinate with senior leadership, monitor MSP requirements, and maintain strict documentation. This role requires travel up to 50% and a strong commitment to Trinity Health values.

Qualifications

• Bachelor’s degree plus claims management experience; clinical health care degree preferred.
• Strong knowledge of professional/general liability and employment practices liability.
• Excellent analytical, written and oral communication skills.
• Ability to meet deadlines and adapt to shifting priorities in a collaborative environment.

Responsibilities

• Investigate, evaluate and resolve claims assigned by the (Senior) Area Claims Manager.
• Formulate and implement thorough investigation plan; evaluate liability, damages and standard of care.
• Establish claim resolution strategy with defense counsel and negotiate settlement within authority.
• Notify excess insurer and provide file updates.
• Maintain a diary system and update claim files per documentation guidelines.
• Present claim information at internal claim reviews.
• Represent Trinity Health at case evaluations, settlements, mediations and trials.
• Direct outside defense counsel and approve fees and expenses.
• Monitor Medicare Secondary Payer requirements and related MSP language.
• Identify loss control issues and document risk modifications in file and STARS.
• Adhere to IRMS and Trinity Health policies.
• Maintain knowledge of applicable laws/regulations and compliance program.

Skills

Liability claims management

Risk management

Analytical skills

Communication (oral & written)

Independent work

Travel readiness

Knowledge of medical/legal terminology

Education

Bachelor's degree

Tools

STARS system

CMS guidelines

Job description

Trinity Health seeks a skilled claims professional to investigate and resolve professional, general, and employment practices liability claims. You will develop investigation plans, assess liability and damages, and manage settlements with defense counsel.

You will coordinate with senior leadership, monitor MSP requirements, and maintain strict documentation. This role requires travel up to 50% and a strong commitment to Trinity Health values.