Claims Services Consultant

Carilion Clinic; Roanoke, Virginia, Seattle (VA, MN, WA); On-site; USD 60,000 - 100,000; Full time

Job summary

An established healthcare provider is seeking a Claims Consultant to enhance their litigation management efforts. This pivotal role involves overseeing malpractice claims, collaborating with legal counsel, and ensuring compliance with regulations. The ideal candidate will possess a strong background in healthcare or legal fields, excellent communication skills, and a passion for risk mitigation. Join a dynamic team dedicated to transforming healthcare through innovation and collaboration. This position offers a chance to make a real impact in a supportive environment where your contributions are valued.

Qualifications

• 3-5 years experience in claims management or healthcare litigation.
• Strong organizational skills and proficiency in Microsoft Office Suite.

Responsibilities

• Manage 50-60% of open malpractice and liability claims.
• Conduct investigations and coordinate with external defense attorneys.
• Ensure compliance with HIPAA and legal standards.

Skills

Claims Management

Litigation Management

Risk Mitigation

Communication Skills

Data Analysis

Microsoft Office Suite

Education

Registered Nurse (BSN)

Bachelor's Degree in Health Science

Paralegal

Tools

Risk Master

Epic

Job description

How You'll Help Transform Healthcare:

Join Carilion Clinic as a Claims Consultant - Advance Your Career in Healthcare Litigation Management

Carilion Clinic is seeking a detail-oriented and experienced Claims Consultant to support our Director of Claims in managing professional and general liability claims within a dynamic healthcare environment. This role plays a key part in litigation management, compliance, and risk mitigation for one of Virginia's leading healthcare systems.

As a Claims Consultant, you will independently manage 50-60% of open malpractice and liability claims while serving as a resource and mentor to Claims Specialists. You'll collaborate with legal counsel, healthcare providers, and internal stakeholders to ensure effective claims handling, regulatory compliance, and risk management.

Key Responsibilities:

• Lead the litigation management process for professional liability and general liability claims in coordination with the Director of Claims.
• Serve as the primary liaison with external defense attorneys, ensuring smooth communication and case coordination.
• Conduct thorough investigations at the direction of legal counsel, gathering critical documentation, medical records, and evidence for active claims.
• Coordinate and attend depositions, legal hearings, and provider preparation meetings.
• Oversee the Attorney Assist Process to ensure compliance with HIPAA and legal standards before engaging external counsel.
• Produce loss-run reports, claims management letters, and support audit responses for BRIC insured providers, ensuring alignment with regulatory and governmental requirements.
• Perform claims data trend analysis, reporting insights to leadership and escalating risk patterns as needed.
• Manage insurance verification and claims history requests for current and former physicians, residents, and mid-level providers, supporting credentialing and reappointment processes.
• Collaborate with risk managers, department heads, and physicians upon notification of malpractice filings, potential compensatory events, or attorney representation.
• Ensure compliance with internal policies, legal requirements, and industry best practices in all aspects of claims consulting and litigation support.

What We Require:

Education: Registered Nurse (BSN) or bachelor's degree in health science or Paralegal.

Experience: Minimum three to five years experience required in field. Experience in medical malpractice, healthcare, or the legal field preferred.

Licensure,certification, and/or registration: Advanced education in the field of Risk management or claims management strongly prefered.

Other Minimum Qualifications: Excellent written and verbal communication skills, with appropriate use of grammar, spelling and/or punctuation. Knowledge of office procedures and equipment. Must have strong organizational skills and be self-motivated. Must be proficient with Microsoft Office Suite including Word, Excel, PowerPoint, Risk Master, and Epic. Must be able to deal with patients, attorneys, and employees at all levels in a diplomatic manner.

About Carilion

This is Carilion Clinic ...

An organization where innovation happens, collaboration is expected and ideas are valued. A not-for-profit, mission-driven health system built on progress and partnerships. A courageous team that is always learning, never discouraged and forever curious.

Headquartered in Roanoke, Va., you will find a robust system of award winning hospitals, Level 1 and 3 trauma centers, Level 3 NICU, Institute of Orthopedics and Neurosciences, multi-specialty physician practices, and The Virginia Tech Carilion School of Medicine and Research Institute.

Carilion is where you can make your own path, make new discoveries and, most importantly, make a difference. Here, in a place where the air is clean, people are kind and life is good. Make your tomorrow with us.

Requisition Number: 151777
Employment Status: Full time
Location: CASB - Carilion Administrative Services Building
Shift: Day
Shift Details: 8am-4:30pm M-F
Recruiter: DAVID L NIVEN
Recruiter Phone: [phone]
Recruiter Email: [e-mail]
For more information, contact the HR Service Center at 1-800-599-2537.

Carilion Clinic is an Equal Opportunity Employer: We provide equal employment opportunities to all employees and applicants without regard to race, color, religion, sex, national origin, age (40 or older), disability, genetic information, or veterans status.
Carilion Clinic is a drug-free workplace.

Please see job description

PI269465030