Employment Type: Full time
Shift: Day Shift
Description:
- Responsible for strategizing and implementing a cost effective and successful process to manage Hospital Professional Liability (HPL), General Liability (GL) and Employment Practices Liability (EPL) claims and litigation, and co-manages uninsured litigation across the system.
- 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.
General Management Responsibilities:
- 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.
Claim Management Responsibilities:
- 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.
Other Responsibilities:
- 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;
- 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;
- 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 ClearSight 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 Program and Code of Conduct; as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior.
MINIMUM QUALIFICATIONS:
- Bachelor’s degree in a related field, or an equivalent combination of