Claims Manager

Advocate Health; Charlotte (NC); Hybrid; USD 65,000 - 98,000; Full time

Benefits offered by this job

Paid Time Off

Health insurance

Retirement plan

Education assistance

Parental leave

Job summary

Advocate Health in Charlotte, NC, is seeking a Risk Management professional to lead the enterprise claims and litigation program across assigned sites with a flexible, mostly remote schedule and occasional onsite travel to Charlotte, NC.

The role requires a Bachelor’s degree in healthcare administration or related field, 5 years of healthcare risk/claims experience, and may require CP HR or JD/MS in healthcare administration; strong communication and data-analysis skills are essential.

Qualifications

• Bachelor’s degree in healthcare administration, law, or related field.
• Typically requires 5 years of claims, insurance, legal or risk management experience in a healthcare setting.
• Certified Professional in Health Care Risk Management (CPHR) within 1 year preferred or similar license/certification.
• Juris Doctor or Master’s in healthcare administration preferred.
• Strong communication with diverse stakeholders and leadership experience.

Responsibilities

• Manage enterprise claims and litigation program at assigned sites; act as site expert and resource.
• Collaborate with site and medical staff leadership on risk reduction and loss prevention programs.
• Disseminate claims and risk data reports for tracking and trending.
• Ensure timely notice and communication for all claims under Advocate Health reinsurance programs.
• Lead enterprise Risk Management Education efforts at assigned sites.
• Enter data accurately in claims management system and support platform improvements.

Skills

Leadership

Communication

Data analysis

Microsoft Office

Presentation skills

Cross-functional collaboration

Time management

Education

Bachelor's degree in healthcare administration or related field

Juris Doctor or Master’s in healthcare administration (preferred)

Tools

Excel

Access

PowerPoint

Word

Claims management system

Job description

Department:

11204 Enterprise Corporate - Risk Management

Status:

Full time

Benefits Eligible:

Yes

Hou** rs Per Week:

40

Schedule Details/Additional Information:

Full Time, Dayshift Monday - Friday. This position will mostly be remote with need to assist in Charlotte, NC travel to court, mediations, etc. Seeking applicants within NC based on local onsite needs.

No relocation and no sponsorship or transfer of visa for this position now or in the future.

Pay Range:

$47.50 - $71.25

Major Responsibilities:

• Managesand executesthe multi-million-dollarenterprise claims and litigation management programat assigned site(s).Siteexpertandresourcefor all claims-relatedsubjects.
• In collaboration withsite and medical staff leadership,executessystem-wideprogramfor developing and implementing risk reduction andfinancial lossprevention strategies.Disseminates claims and risk data reports for assigned site(s) for tracking/trending.
• Executesstrategyforall professional and general liability claimsto ensure the best resolution possible.Promotesbest practices and consistent, effective claims handling in alignment with enterprise goals.Ensures all claimsare appropriately financially reserved.Responsible fortimelynotice and communicationfor all claims insured under the Advocate Health reinsurance programs.Monitors all aspects ofclaims activity including in-person court attendance for trial management.
• CollaborateswithClaims and Risk leaders in ensuring acoordinated, comprehensive,high qualityenterprise Risk Management Education Program at assigned site(s).
• Executesall data entry in claims management system, ensuring accuracy and timeliness of claims data.Executesstrategy and platform improvement initiatives.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• Bachelor’s degree in healthcare administration, law,or related fieldrequired.

Experience Required:

• Typically requires5years of claims, insurance, legal or risk management experience in a healthcare setting.

Licensure, Registration, and/or Certification Preferred:

• Certified Professional in Health Care Risk Management designation issued by the American Hospital Association (AHA) needs to be obtained within 1 year, orsimilar licenseor certification.

Education Preferred:

• Juris doctor of master’s degree in healthcare administration or related field preferred.

Experience Preferred:

• Legal,nursingor other clinical knowledge, background, and experience preferred.

Knowledge, Skills & Abilities Required:

• Demonstrated abilityleadingcollaborative activities, chairingmeetingsand making presentations to physicians and executive leadership.
• Demonstrated ability to work and function in a complex corporate, system environment.
• Ability to communicate effectively with individuals of diverse backgrounds from all disciplines and levels of the organization. Must be comfortable and able toeffectively and compassionately communicate with patients, claimants, and family membersregardingdifficult topics.
• Strong decision-making and critical thinking skills.
• Strong ability to manage multiple teams of people and projects simultaneously.
• Must be proficient in Microsoft Office (Excel, Access,PowerPointand Word) orsimilar products.
• Demonstratedexpertisein statistical/data analysis, data presentation, organizational ability, and attention to detail.
• Demonstrated ability to draft comprehensive reports and memosregardingall areaspertaining tothe Risk function.

Physical Requirements and Working Conditions:

• Generally exposed to a normal office environment.
• Operates all equipment necessary to perform the job including computer use.
• Exposure toroad and weather hazards during job-related trips.
• Must be able to sit, stand, bend, and liftfrequentlythroughout workday.
• Must be able to walk sufficiently to coverentiretyof site/facility.
• Must have clear speech,hearingand vision.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our CommitmenttoYou:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training

• Premium pay such as shift, on call, and more based on a teammate’s job

• Incentive pay for select positions

• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs

• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability

• Flexible Spending Accounts for eligible health care and dependent care expenses

• Family benefits such as adoption assistance and paid parental leave

• Defined contribution retirement plans with employer match and other financial wellness programs

• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.