Claims Manager

Advocate Health; Charlotte (NC); On-site; USD 120,000 - 180,000; Full time

Job summary

Advocate Health is seeking a senior risk management leader to oversee the enterprise claims and litigation program at the Charlotte site and collaborate with medical staff to develop loss-prevention strategies.

The role requires a strong background in healthcare risk management, data analysis, and executive communication, with a focus on coordinated education and reporting across the system.

Qualifications

• Bachelor's degree in healthcare administration, law, or related field is required.
• Typically requires 5 years of claims, insurance, legal or risk management experience in a healthcare setting.
• Juris doctor or master's degree in healthcare administration preferred.

Responsibilities

• Manages and executes the enterprise claims and litigation management program at assigned site(s).
• Develops and implements risk reduction and financial loss prevention strategies across the enterprise.
• Ensures timely notice and communication for all claims under Advocate Health reinsurance programs and maintains financial reserves.
• Collaborates with Claims and Risk leaders to deliver a coordinated enterprise Risk Management Education Program.
• Performs data entry in claims management system and drives platform improvements.

Skills

Leadership

Collaboration

Communication

Data analysis

Executive presentation

Microsoft Office

Risk management

Attention to detail

Education

Bachelor's degree in healthcare administration or related field

Juris Doctor or Master's in healthcare administration

AHA risk mgmt certification (CHRM/CPRM)

Tools

Microsoft Office

Job description

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.