Claims Manager

1100 Baystate Administrative Svc.; United States; Hybrid; USD 119,000 - 162,000; Full time

Benefits offered by this job

Competitive pay and benefits

Tuition assistance and professional发展

Retirement savings with employer match

Job summary

Baystate Health is seeking a Claims Manager to oversee complex, high-exposure self-insured and insured claims, including professional liability, general liability, EPL/D&O. The role involves investigating claims, supervising defense counsel, and developing defense strategies to achieve favorable outcomes.

The position requires strong negotiation, mediation, and data reporting skills. It offers a hybrid schedule with an office at 280 Chestnut Street and interaction with risk management teams

Qualifications

• Bachelor's degree required.
• Master's degree preferred in Nursing, Risk Management, Healthcare related field or J.D.
• Seven years of managing professional liability claims, including complex cases.

Responsibilities

• Conducts thorough investigations of assigned claims and other matters, gathering data efficiently.
• Evaluates and sets reserves on claims with oversight.
• Monitors all assigned claims to ensure development and resolution when appropriate.
• Assigns defense counsel and collaborates to select experts and develop defense strategies.
• Negotiates settlements and manages litigation with a focus on optimal outcomes.
• Educates and presents on Risk and Claims Management; reports to Baystate committees and the captive board.

Skills

Communication skills

Analytical thinking

Interpersonal skills

Decision making

Negotiation skills

Mediation knowledge

Education

Bachelor's degree

Master's degree preferred

Risk management

Healthcare field

J.D.

Job description

Claims Manager

The Claims Manager is responsible for the overall management of complex, high exposure self-insured Professional Liability, General Liability, Employment and Directors and Officers Liability claims as well as claims and lawsuits insured under the Community Provider Insurance Program: (a) investigates claims, oversees and manages defense counsel, develops defense strategies, and negotiates settlements; (b) attends and monitors depositions, trials, and mediations; (c) assists in the presentation of claims data and reports to the Baystate Claims Committees and Baystate Health's captive (Baystate Health Insurance Company) Board of Directors; (d) partners on the Communication, Apology, and Resolution (CARe) cases for early assessment and resolution of significant unanticipated adverse outcomes of care; (e) interacts with patients and families who have experienced adverse outcomes in a caring and compassionate manner while adhering to organizational objectives and fulfilling duties in a professional manner to achieve the best ethical, safety, and financial outcomes; (f) collaborates with the Risk Managers to report safety concerns identified in claims to the appropriate departments towards prioritizing operational objectives with executives and senior leaders across the system; (g) educates and presents on Risk and Claims Management.

Responsibilities

Conducts a thorough investigation of assigned claims, lawsuits and other matters, including review of complex medical issues, interviews of medical personnel and staff, and review of internal investigation of care issues. Gathers data and information in an efficient and effective manner. Documents activities and results of the investigation. Maintains claims files and updates files and databases as claim develops. Evaluates and sets appropriate reserves on claims in compliance with the Baystate reserving philosophy with oversight of Sr. Director of Claims, Litigation and Insurance. Adjusts reserves to reflect exposure as case develops. Monitors all assigned claims to assure appropriate development of the case, with the goal of achieving resolution when appropriate. Assigns defense counsel from approved panel counsel list or with approval of Sr. Director of Claims, Litigation & Insurance. Works with defense counsel to select appropriate expert witnesses and develop and approve defense strategies. Oversees and manages counsel throughout the litigation with the goal of bringing claim to appropriate resolution. Monitors defense counsel’s adherence to Litigation Management Guidelines. Reviews and approves expense and legal invoices to ensure compliance with billing guidelines Attends depositions of the parties and monitors trials as a corporate representative. Develops trial strategies with defense counsel and recommends high-low agreements where appropriate. Negotiates settlement of complex medical malpractice claims and other assigned claims. Updates and discusses potential settlement of claims with appropriate management personnel. Utilizes legal tools including mediation to negotiate settlements where appropriate. Provides information to reinsurers as requested, including defense and/or settlement strategies, status of litigation, discovery updates, expert reviews, current reserves and financial exposure of assigned claims. Conducts investigations of employment and Directors & Officers claims in collaboration with Human Resources. Assigns and monitors defense counsel and assists in the development of defense strategies. Attends MCAD proceedings, depositions, mediations, and trials on behalf of the corporation. Negotiates settlement of employment claims within Baystate's self-insured retention. Works in conjunction with Baystate's commercial EPL/D&O insurance carrier. Establishes and maintains processes related to CARe and other system-wide initiatives relative to the Baystate Health Communication & Resolution Program. Investigates adverse patient outcomes meeting CARe criteria in collaboration with Risk Managers and the CARe Program Manager to determine need for outside expert reviews and establish a plan of action for further evaluation and analysis. When feasible, assures prompt and fair resolution of claims. Participates in claims data collection and reporting to monitor internal severity and frequency trends, to assure adequate reserving practices and to benchmark against the insurance marketplace. Mentors other claims handlers, CARe managers and Risk Managers as needed. Participates in quarterly regional insurance captive benchmarking meetings. Complies with state and federal regulatory reporting requirements such as NPDB, BORM, and MMSEA.

Requirements

• Bachelor's Degree required, Master's Degree preferred in Nursing, Risk Management, Healthcare related field or J.D.
• Seven years of managing professional liability claims, including complex cases.
• Familiarity with state and federal laws pertaining to medical professional liability, general liability and employment practices liability (to include Directors & Officers) claims.

Preferred Work Experience

• Prior medical malpractice, employment practices liability, or related claims experience; clinical experience; risk management experience; or legal experience involving medical malpractice litigation.

Skills and Competencies

• Excellent written and oral communications skills, analytical thinking, interpersonal skills and ability to make decisions.
• Strong negotiation skills including complex, high value professional liability claims.
• Experience with mediation and arbitration and knowledge of medical terminology.

Schedule & Location

Full Time, Monday - Friday. Hybrid Opportunity- ability to work a hybrid schedule once fully orientated – Office Location- 280 Chestnut Street

About Baystate Health

Baystate Health is an integrated healthcare system serving patients and communities throughout western Massachusetts. Our network includes Baystate Medical Center, Baystate Children's Hospital, Baystate Noble Hospital, Baystate Franklin Medical Center, Baystate Wing Hospital, Baystate Medical Practices, and Baystate Home Health & Hospice. Whether you provide direct patient care, clinical services, or operational support, your work at Baystate Health helps improve the health of the communities we serve.

Benefits That Support You

• Competitive Pay & Benefits: Medical, dental, and vision coverage, including local Health New England plans.
• Tuition & Training: Tuition assistance, CEUs, and professional development opportunities.
• Career Growth: Clinical advancement, leadership development, and internal career opportunities.
• Retirement: Retirement savings and employer match.
• Paid Time Off: Generous PTO for eligible employees.
• Education: Bachelors Degree (Required)
• Certifications: Compensation Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries may vary by position and will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees. Minimum - Midpoint - Maximum $118,934.00 - $136,718.00 - $161,720.00

Equal Employment Opportunity Employer

Baystate Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, marital status, national origin, ancestry, age, genetic information, disability, or protected veteran status.

About Baystate Health (Additional)

Baystate Health (BH) is one of New England’s leading and largest integrated health care organizations, serving a population of nearly one million people throughout western New England. With roots dating back to the founding of Springfield City Hospital in 1873, Baystate Health has been providing high-quality and compassionate health care in western Massachusetts for more than 145 years. With more than 12,000 employees, a medical staff of nearly 3,100 physicians, and a net patient service revenue of more than $1.4 billion, the ever-growing health system includes five Massachusetts hospitals and the Baystate Mary Lane Outpatient Center in Ware: Baystate Medical Center in Springfield Baystate Children’s Hospital (located at Baystate Medical Center) Baystate Franklin Medical Center in Greenfield Baystate Wing Hospital in Palmer Baystate Noble Hospital in Westfield