Claims Specialist - Risk Finance

CHRISTUS Health; Irving (TX); On-site; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking a Regional Claims Specialist to support litigation efforts and manage claims within a dynamic healthcare environment. This role is vital for ensuring effective resolution of disputes and involves working closely with legal teams and healthcare providers. The Specialist will be responsible for investigating claims, preparing reports, and negotiating settlements, all while providing valuable insights to improve risk management practices. If you have a passion for healthcare and a knack for legal processes, this opportunity offers a chance to make a significant impact in a supportive and collaborative team setting.

Qualifications

• 3-5 years in healthcare with exposure to clinical care or risk management.
• RN required; Paralegal Certificate preferred.

Responsibilities

• Support litigation management and defense of claims.
• Investigate patient complaints and prepare reports.

Skills

Organizational Skills

Leadership

Problem-Solving Skills

Computer Literacy

Public Speaking

Education

Bachelor of Science in Nursing (BSN)

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 Managers, 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 communicates recommendations for handling. Investigation includes, at times, on-site interviewing of providers.
• Prepares privileged work product reports containing clinical analysis and provides recommendations to the team for handling.
• When appropriate, negotiates settlements within designated authority and prepares settlement agreements using language approved by the CHRISTUS Vice President of Litigation.
• Attends depositions, trials, hearings (as needed), and mediations. Negotiates settlements at mediation or directly with claimants or plaintiffs’ counsel within designated authority. Drafts settlement agreements and analyzes MMSEA issues.
• Identifies and evaluates trends and reports 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 based on follow-up investigations.
• Provides liability analysis and investigative support to defense counsel upon 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, providing 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 are 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

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