REMOTE Area Claims Manager

Employment Type

Full time

Day Shift

Position allows for work remote/work from home.

• Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision and Values of Trinity Health in behaviors, practices, and decisions.
• Ensures adherence to Trinity Health Insurance and Risk Management Services (IRMS) Policies and Procedures.
• Complies with Best Practice protocol in management of assigned claims.

• Reviews new incidents as assigned and opens claims as needed. Assesses coverage of all potential Trinity Health insured and obtains formal coverage analysis if indicated.
• Formulates and implements a thorough investigation plan for each claim. Evaluates claim with respect to standard of care, liability, causation, and damages. Considers witness credibility and expert opinions and determines the value of the claim.
• Establishes and completes timely review of indemnity and expense reserves
• Participates in the management of uninsured litigation across the system, as assigned.
• Determines claim resolution strategy (including trial) and obtains required settlement authority per Settlement Authority Matrix. Adhering to delegated authority limits, negotiates or directs the negotiation of the claims/lawsuit to resolution.
• Notifies excess insurer of claims according to established criteria and provides file updates pursuant to reporting guidelines.
• Maintains a diary system to monitor all open claims. Updates claim files per Best Practice Protocol.
• Ensures adherence to IRMS Legal Hold policy.
• Participates in Regional Claims Review and Large Loss meetings to ensure matters are presented consistent with the applicable policy.
• Represents Health Ministry/Trinity Health in participating in case evaluations, settlement conferences, facilitations, mediation, and trials.
• Retains approved defense counsel on a per claim basis. Directs and supervises the work of outside defense counsel pursuant to the litigation protocol. Reviews and responds to attorney reports and recommendations as appropriate. Reviews and approves the defense counsel fee and litigation expenses and adherence to preferred vendor use.
• Responsible for compliance with Medicare reporting requirements.

• Works collaboratively with Loss Control Directors to identify risk management trends, issues, and opportunities.
• Keeps IRMS management apprised of significant case developments, as appropriate.
• Directs and supervises Claims staff in maintaining and updating Clearsight database.
• Ensures adherence to NPDB and State reporting requirements.
• Communicates with Health Ministry (HM) Risk Management/Patient Safety colleagues relative to all aspects involving claims management.
• This includes:
  • Communication related to new matters, and potential exposure;
  • Preservation of evidence, documents, electronic data as needed;
  • Unsupportive reviews, or other significant case development as needed;
  • Requests for authority and risk modifications as required per procedure; and
  • Adherence to protocols (venue specific) for protected documents involved in litigation.
• Serve as liaison for HM senior leadership relative to pending matters and potential exposure.
• This includes:
  • Requests for authority per Settlement Authority Matrix;
  • Provides updates as needed regarding high exposure claims;
  • Advises as to high profile/media sensitive matters; and
  • Provides comprehensive claims review as requested for RHM senior leadership.
• Develops individual goals in conjunction with Claims Department goals.
• Attends and participates in regularly scheduled Team and Department meetings.
• Reviews monthly Clear Sight reports for accuracy, data integrity and reserve assessment.
• Participates in IRMS and/or Trinity Health committees as requested by the Director of Liability Claims to provide subject matter expertise.
• Maintains awareness of existing and proposed legislation, court decisions and emerging trends in claims litigation specific to the Team’s venue. Recommends process and/or procedure changes as appropriate.
• Maintains a working knowledge of applicable Federal, State, and local laws/regulations; the Trinity Health Integrity and Compliance…