Executive Director of Claims & Insurance

Position Title

Executive Director of Claims & Insurance

Bell Hospital

Position Summary / Career Interest:

The Executive Director of Claims & Insurance has broad responsibility, in collaboration with the UKHA General Counsel, for the identification, prevention and mitigation of real and potential risk to the University of Kansas Physicians (UKP), its employed practitioners, and affiliates and for the University of Kansas Hospital Authority overall. This position supports building and evolving of the enterprise risk management program - designing frameworks, influencing decisions, and ensuring UKP's risk posture aligns with the strategic goals of the University of Kansas Health Authority (UKHA) and UKP. The position will collaborate with senior and executive leadership, risk owners, and external partners to develop, implement, and continuously improve the overall risk financing positioning of the health system. The Executive Director of Claims & Insurance provides leadership and direction to a team of insurance and claims professionals and has a dual reporting relationship to UKHA General Counsel and UKP senior leadership.

Responsibilities and Essential Job Functions

• Lead and evolve the health system's enterprise risk management program with a focus on continuous improvement and patient safety.
• Act as point of contact for captive manager in the day-to-day captive and RRG operations.
• Manage health system property and casualty insurance portfolio in conjunction with the General Counsel and Director of Insurance.
• Present risks and appropriate mitigation strategies to senior leadership, influencing prioritization and resource allocation.
• Facilitate early claims resolution process for serious unanticipated outcomes.
• Provide claims leadership, including serving as co-chair for the Claims Committee.
• Actively participate in root cause analysis meetings as appropriate to review adverse/sentinel event occurrences and near misses that affect, or may affect or involve, any UKP practitioner.
• Monitor external threats, macroeconomic trends, and regulatory shifts. Collaborate with appropriate partners to develop necessary response.
• Collaborate with University of Kansas Health System ("UKHS") medical staff and medical staff leadership to facilitate investigations, assuring all relevant privileges and protections are triggered and preserved.
• Provide independent, unbiased and discrete assistance to UKP practitioners regarding potential claims at the pre-claim stage. Investigate cases identified as potential risk issues, with a goal of avoiding or minimizing the UKP practitioner's professional liability and harm to professional reputation.
• Collaborate with UKP Human Resources to ensure that HR-related issues and findings are effectively documented and necessary corrective actions are taken.
• Champion risk awareness and continuous improvement. Participate in compliance oversight, monitor accreditation and regulatory inspections, surveys and visits. Participate as member of facility or enterprise crisis management teams pursuant to applicable policies.
• Notify the Health Care Stabilization Fund ("HCSF") of any claims, demands, or lawsuits or issues likely to result in a claim. Review and investigate patient/family complaints, patient demand letters, and incident reports. In collaboration with UKHS and UKP, make recommendations to HCSF if requested regarding disposition of complaints and demands.
• Assist physicians with response to patient complaints in coordination with Risk Management and Patient Relations. Collaborate with Regulatory, Clinical Risk Management and other relevant departments to facilitate compliance with Medicaid/Medicare and other federal and state regulations.
• When necessary or prudent, request counsel for practitioner. As requested by the HCSF, serve as the liaison to attorneys for requests to interview UKP practitioners, obtain depositions for subsequent treating practitioners, and identify and prepare UKP practitioner witnesses.
• As requested by the HCSF, assist with preparation for trials and attend mediations and trials on behalf of UKP and UKP practitioners. Collaborate with Legal and Compliance departments to facilitate responses, including corrective actions to any Statement of Deficiency involving the OIG, OCR, KDHE, FDA, FBI, CMS and other regulatory and/or enforcement agencies. As requested by the HCSF, participate with Senior Leadership and legal counsel in formulating defense strategies.
• Assist practitioners with answering questions on licensure and credentialing applications which includes obtaining necessary documents to accompany the application.
• Review peer review requests and prepare documents for peer review committees.
• Request bill holds; make recommendations for waiver of bills; and attend bill-hold meetings.
• Review discharge from practice letters and discuss and evaluate patients that physicians wish to discharge from their practice.
• Assist district attorney or other prosecutor in identifying witnesses for criminal, child custody, guardianship, and child in need of care cases; facilitate practitioner attendance.
• Ensure compliance with various codes, laws, rules and regulations concerning patient care (including those mandated by state and federal agencies), incident reporting and investigation activities.
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

• Bachelors Degree
• Juris Doctor
• 10 or more years of claims experience in a health care environment.
• 5 or more years of experience in a leadership role with board-level exposure.
• 5 or more years of experience with alternative risk financing.

Preferred Education and Experience

• Master's Degree in Health Care Administration

Preferred Licensure and Certification

• RPLU - Registered Professional Liability Underwriter upon Hire
• CCI - Certificate in Captive Insurance upon Hire
• AIC - Associate in Claims upon Hire
• AINS - Associate in Insurance upon Hire

Knowledge Requirements

• Deep knowledge of risk frameworks, tools, regulatory requirements, and health care law issues impacting enterprise and practitioner risk.
• Experience with supporting CANDOR or Early Claims Resolution programs.
• Effective presentation skills; articulate, diplomatic, and persuasive communicator.
• Ability to manage/handle stress while under pressure from many involved parties. Able to delegate appropriately.
• Ability to interface with a variety of professionals, including board members, medical staff and senior leadership, attorneys, accountants, actuaries, brokers, underwriters, etc.
• Demonstrated skills in strategic planning, implementing and evaluating programs.
• Knowledge of clinical and non-clinical loss control and claims administration.
• Ability to prioritize tasks and see the big picture.
• Deep knowledge of risk frameworks, tools, and regulatory requirements.
• Demonstrated ability to offer creative, innovative solutions to prevent or reduce risk.
• Ability to manage information and advice in a confidential manner.
• Maintain depth of knowledge of applicable legal and regulatory requirements.

Time Type:

Full time

Job Requisition ID:

R-47932

Important information for you to know as you apply:

• The health system is an equal employment opportunity employer. Qualified applicants are considered for employment without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, ancestry, age, disability, veteran status, genetic information, or any other legally-protected status. See also Diversity, Equity & Inclusion.

• The health system provides reasonable accommodations to qualified individuals with disabilities. If you need to request reasonable accommodations for your disability as you navigate the recruitment process, please let our recruiters know by requesting an Accommodation Request form using this link asktalentacquisition@kumc.edu.

• Employment with the health system is contingent upon, among other things, agreeing to the health-system-dispute-resolution-program.pdf and signing the agreement to the DRP.

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