Claims Specialist (Registered Nurse) - Risk Finance

CHRISTUS Health; Irving (TX); On-site; USD 90,000 - 140,000; Full time

Job summary

CHRISTUS Health is seeking a Regional Claims Specialist to support the Vice President of Litigation and the Claims Team in investigation, management, and defense of health-care related claims across affiliated centers. The role involves on-site interviews, settlement negotiations, and active involvement in pre-litigation and litigation proceedings.

The candidate should bring 3–5 years of healthcare risk experience, a BSN, and relevant legal or paralegal qualifications. RN licensure is required.

Qualifications

• BSN required.
• 3–5 years in a health care setting with exposure to risk management or operations.
• Some legal experience (e.g., Paralegal, Legal Nurse Consultant) preferred; JDs will be considered.
• Adjuster licensure and/or CPHRM certification a plus.
• Three to five years in a health care setting with exposure to clinical care, risk management or operations.
• Some legal experience (i.e., Paralegal, Legal Nurse Consultant) preferred.

Responsibilities

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Provides support to the VP of Litigation and Claims Team in investigation, management, resolution and defense of liability events, claims, appeals, arbitrations or other disputes.
• Investigates patient and claimant complaints and demands and communicates recommendations; on-site interviews of providers may occur.
• Negotiates settlements within designated authority and drafts settlement agreements.
• Attends depositions, trials, hearings, and mediations; analyzes MMSEA issues and provides counsel with risk assessment.
• Teaches and participates in risk management education and system-wide events.

Skills

Leadership

Public speaking

Teaching

Interpersonal skills

Education

BSN

Paralegal Certificate

JD considered

Tools

PowerPoint

Excel

Job description

Summary

A CHRISTUS Regional Claims Specialist represents CHRISTUS Health and its facilities and providers and provides support to the Vice President of Litigation, the other Regional Claims Specialist and the Claims Team in the investigation, management, resolution and defense of claims, appeals, arbitrations or any other form of disputes. The duties vary including support of matters in pre‑litigation and active litigation. Other legal work involves management of subpoenas, court appearances, mediations and trial appearances. Travel is a requirement (25-30%). Serves as liaison to all affiliated health care centers in the investigation, resolution and defense of claims.

Responsibilities

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Provides support to the Vice President of Litigation, other Clinical Regional Claims Mangers and the Claims Team in the investigation, management, resolution and defense of liability events, claims, appeals, arbitrations or any other form of disputes.
• Evaluates and investigates patient and claimant complaints and demands and communicate recommendations for handling. Investigation includes, at times, on site interviewing of providers.
• Prepares privileged work product reports containing with clinical analysis regarding same and provides recommendations to the team for handling.
• When appropriate, negotiates settlements within designated authority, prepare settlement agreements using language of settlement agreements approved by the CHRISTUS Vice President of Litigation.
• Attends depositions, trials, hearings (as needed) and mediations. Negotiates negotiate settlements at mediation or directly with claimant or plaintiff’s counsel within designated authority. Drafts settlement agreements. Analysis of MMSEA issues.
• Identifies and evaluates trend and report analysis of quality and risk issues to assist in reducing the frequency of preventable adverse occurrences. Prepares presentations to facility leadership concerning trends and recommendations for improvement.
• Investigates all assigned Events, UPLE, Injured Asserts, Attorney Asserts, Medical Review Panels and Suits.
• Retains oversight of defense of claims interacting with defense counsel and defense teams.
• Recommends reserves and adjustments to same indicated by any follow‑up investigation.
• Provides liability analysis and investigative support to defense counsel on commencement of litigation.
• Prepares status reports or other presentations relative to active claims based on regional assignments.
• Monitors trials, mock trials, jury studies and depositions and provides analysis and recommendations regarding litigation management to the CHRISTUS Vice President of Litigation.
• Monitors and participates in MMSEA compliance and reporting with the support of internal and external counsel.
• Monitors Outside Counsel compliance with guidelines and billing requirements.
• Interacts regularly with external attorneys related to the oversight and management of claims and all matters in litigation.
• Coordinates, Plans and Participates in facility claims reviews.
• Participates in Teaching events across the system as needed including teaching nursing residents on matters related to legal claims.
• Participates in risk management surveys of facilities.
• Must have organizational skills, Leadership, and problem‑solving skills.
• Must have computer literacy, PowerPoint /Excel skills a plus.
• Must have demonstrated, organizational and interpersonal skills.
• Enjoys teaching and public speaking.

Job Requirements

Education/Skills

• BSN required.

Experience

• Three to Five years in a health care setting with exposure to some combination of clinical care, risk management or operations.
• Some legal experience (i.e., Paralegal, Legal Nurse Consultant) Preferred.

Licenses, Registrations, or Certifications

• RN required.
• Paralegal Certificate Preferred. JDs will be considered.
• Adjuster licensure and/or CPHRM certification a plus.

Work Schedule

5 Days - 8 Hours

Work Type

Full Time