REMOTE Sr Manager Area Claims

Position: (REMOTE) Sr Manager Area Claims
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* Employment Type:

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* Full time

** Shift:*
* Day Shift

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* Description:

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* Responsible for the personnel, operations, and oversight of a claims management Team in Regional Claims Office.  Oversees the day-to-day operations for assigned team. Designs and directs the claim investigation process; evaluates claim with respect to liability, causation, and damages; develops a resolution strategy and fairly and equitably resolves claims and lawsuits.

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* ESSENTIAL FUNCTIONS:

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* _General Management Responsibilities:_

Knows, understands, incorporates, and demonstrates the mission, vision, and values of Trinity Health in leadership behaviors, practices, and decisions. Reports to and receives guidance from Director of Liability Claims and/or Director Claims Services.  Facilitates and ensures communication between the regional claims management team and system office IRMS group. Conducts regular meetings with regional team to promote clear communication, discuss responsibilities and tasks as needed, evaluate individual employee claim load, and provide guidance and support on questions or concerns as needed.

_Team Management Responsibilities:_

Monitors and provides input on staffing needs.  Conducts interviews, evaluates candidates, hires new staff, and provides employee orientation and training. Evaluates staff performance, ensures staff professional development, provides performance feedback, recommends salary actions, and, as necessary, develops performance improvement plans and recommends individual terminations of employment.
Develops and provides guidance related to individual and team goals. Conducts review of progress toward goals and conducts employee performance reviews. Responsible for staff scheduling to include work assignments, employee training, PTO, leaves of absence, trial coverage, etc.  Approves PTO, sick time, and process time off for Team in Kronos timekeeping system. Schedules and conducts regular Team meetings. Approves staff expense reports and time sheets.  

Ensures compliance with required Trinity Health corporate education and compliance. Reviews claim loss reports, assesses complexity of submitted claims and assigns claims as appropriate; serves as a resource for staff to address and resolve issues, as needed. Addresses, resolves and/or escalates technical, legal and claims management issues that may arise.  Monitors work assignments and re-assigns cases/venues as needed to ensure appropriate staffing.

Ensures adherence to Trinity Health IRMS policies and procedures. Identifies, recommends, and participates in the development/modification and communication of policies and procedures as appropriate.

_Claim Management Responsibilities:_

Conducts review of new incidents, PCEs, lawsuits, SREs, and ADCs and analyzes whether an incident needs to be promoted to a claim, whether an Area Claims Manager (ACM) or Claims Specialist (CS) needs to be assigned, and whether any other further action needs to be taken.
Assesses coverage in coordination with assigned claim manager, and partners with Risk Finance relative to complex insurance coverage issues that may arise.
Conducts regular reviews of open files and meets with team members to ensure claims are managed in accordance with best practices.
Considers upcoming actuarial dates and encourages reserve assessment, claim opening and closure in accordance with target dates.  Works with assigned team relative to management of defense counsel.  This includes:

+ Selection of counsel for new matters in conjunction with the Director, Liability Claims and/or Director, Claims Services, when applicable;

+ Ensuring adherence to litigation protocol and billing guidelines;

+ Oversight of file work and strategy, including selection of experts;

+ Identification and resolution of conflicts pertaining to representation; and

+ Settling of billing disputes as needed.

Supervises the work activities of Claims professional staff in reviewing, analyzing, investigating, negotiating, and settling claims in compliance with established standards and expectations.  Conducts file audits in Clearsight to ensure compliance with IRMS Claims Department best practices.  Reviews files to…