Medical Claims Review Manager jobs in Oregon

Description

Providence caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Providence is calling a Sr. Medical Malpractice Claims Manager - Professional Liability who will:

Investigate, Evaluate, and Manage Professional, General and other Liability Claims under the PSJH Insurance Program:

• Communicate with patients, claimants, caregivers, providers, leadership
• Review and analyze medical records, interview witnesses, assist with the discovery process and communicate with facility risk manager regarding evaluation and investigation
• Be responsible for writing insurance policy coverage letters
• Analyze insurance policy documents to address coverage
• Set appropriate indemnity and expense reserves
• Select appropriate medical experts for case review
• Develop a plan of action for assigned claims and update the claims file following all material changes in status
• Review and approve statements for services and take proper steps to pay vendors
• Inform Senior Manager Operations of large or complex claims and claims with potential for media exposure
• Report claims with potential excess exposure to excess insurers
• Ensure compliance with relevant claims reporting procedures and required regulations
• Work with defense attorneys specializing in defense of medical negligence claims
• Have direct responsibility to foster teamwork, operational excellence, and effective communication within the claims team, including other Claims Managers, Claims Reps and Claims Specialists

Maintain Complete Documentation for Each Matter:

• Develop and document for each claim or lawsuit a plan of action for resolution by settlement, trial or other means
• Maintain the electronic file including all material communication, correspondence, analysis, expert opinions, interview summaries and all other material documents in accordance with the Claims Policies and Procedures Manual

Coordinate with Facility Leadership, Risk Managers, Defense Counsel and others:

• Select defense counsel when appropriate from approved counsel list
• Coordinate and consult with risk management on disclosure conversations with patients and families
• Obtain authority for settlement or trial in accordance with policies and procedures or facilitate claims roundtables
• Assist in Regional CEO Conferences with Senior Manager Operations
• Facilitate and participate in case reviews with Risk Managers upon request

Resolve Claims In Accordance with Policies and Regulations:

• Negotiate settlements
• Monitor trials and advise on disclosure and early resolution opportunities
• Report to relevant federal, state, and local regulatory agencies as required
• Close files in accordance with internal policies and procedures and facilitate appropriate reporting to NPDB and state agencies
• Participate in department and claims team projects as assigned to develop and improve procedures, policies; to improve efficiency of department work; and to assist the SVP Chief Risk Officer and Senior Manager Operations as needed

Provide Input to Reduce Risk:

• Provide feedback and recommendations, evaluations, litigation trends, department policies and procedures, system-wide claims and litigation processes, and appropriate System risk management issues
• Provide input for quality and patient safety projects, through the Risk & Integrity Services division and Risk, Claims, & Insurance department

Providence welcomes 100% Remote Work to residents anywhere in the United States with the exception of the following States:

• Colorado
• Hawaii
• Massachusetts
• New York
• Ohio
• Pennsylvania

Required qualifications for this position include:

• Bachelor's Degree in Business Administration, Finance, or another related field of study
• 7 years of relevant general and professional liability claims processing or management experience
• 5 years of direct supervisory or management experience

Preferred qualifications for this position include:

• Certified Professional Healthcare Risk Management (CPHRM)
• 10 years of medical malpractice experience
• Insurance Carrier Experience
• Third Party Professional Negligence Claims Experience
• Experience handling Medical Negligence Professional Liability Claims
• Experience handling Complex General Liability Claims
• Experience Investigating, evaluating and negotiating medical negligence claims
• Experience working with defense attorneys specializing in defense of medical negligence claims
• Experience analyzing medical professional and general liability insurance policy documents and addressing coverage
• Experience writing medical professional and general liability insurance policy coverage letters
• STARS / Riskonnect or similar claims management software experience

Salary Range by Location:

AK: Anchorage:

• Min: $51.16
• Max: $82.36

AK: Kodiak, Seward, Valdez:

• Min: $53.33
• Max: $85.85

Washington: Western:

• Min: $53.33
• Max: $85.85

Washington: Southwest - Olympia, Centralia & Below:

• Min: $51.16
• Max: $82.36

Washington: Tukwila:

• Min: $53.33
• Max: $85.85

Washington: Eastern:

• Min: $45.53
• Max: $73.29

Washington: South Eastern:

• Min: $47.70
• Max: $76.78

Idaho:

• Min: $45.53
• Max: $73.29

Oregon: Portland Metro Region:

• Min: $51.16
• Max: $82.36

Oregon: All cities outside of Portland:

• Min: $47.70
• Max: $76.78

California: Northern California:

• Min: $59.84
• Max: $96.32

California: Humboldt:

• Min: $53.33
• Max: $85.85

California: Southern California:

• Min: $53.33
• Max: $85.85

California: Bakersfield:

• Min: $51.16
• Max: $82.36

Montana: All cities outside of Great Falls:

• Min: $41.19
• Max: $66.31

Montana: Great Falls:

• Min: $39.02
• Max: $62.82

Nevada:

• Min: $53.33
• Max: $85.85

New Mexico:

• Min: $41.19
• Max: $66.31

Lubbock, Levelland, Plainview TX:

• Min: $39.02
• Max: $62.82

TX: Austin, Dallas, Houston, San Antonio:

• Min: $51.16
• Max: $82.36

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.

About the Team

Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Requsition ID: 284908

Company: Providence Jobs

Job Category: Financial Transactions

Job Function: Health Plans Services

Job Schedule: Full time

Job Shift:

Career Track: Business Professional

Department: 4008 SS RIS

Address: WA Renton 1801 Lind Ave SW

Work Location: Providence Valley Office Park-Renton

Pay Range: $See Posting - $See Posting

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.