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Director, Claims Management

TeamHealth Knoxville Full-Time
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JOB DESCRIPTION OVERVIEW:

The Claims Director is responsible for directing and supervising Claim Managers who oversee the handling of medical professional liability claims and the Litigation Support and Claims Administrative Coordinators who provide technical customer service assistance.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Lead and manage the Claims Managers in the processing of medical professional liability claims
  • Monitor the status of a large number of medical professional liability claims across multiple states
  • Responsible for communication with defense counsel, healthcare providers, client hospitals, insurance carriers and group leadership concerning the status of claims
  • Assists in the preparation of large exposure claims to be submitted to the Claims Committee
  • Prepares in depth case analysis and makes settlement recommendations to the AVP
  • Conducts regular claim file audits to ensure compliance with Claims Manual and claim management best practices
  • Acts as primary contact for providers reporting new claims and assigns defense counsel
  • Evaluates the work product of Western Litigation and advises the AVP of any deficiencies in performance
  • May handle a small case load
  • Responsible for the integrity of claims data in the STARS System
  • Assist, as necessary, in attending mediations or trials
  • Maintain up to date knowledge on liability laws and practices and participates in professional organizations
  • Responsible for special projects as needed or directed



QUALIFICATIONS / EXPERIENCE:

  • BS/BA degree in Business, Healthcare, Risk Management or equivalent insurance work experience
  • 10 years of medical professional liability claims experience with at least five years at a supervisory level
  • Demonstrated leadership and management skills
  • Advanced negotiation skills
  • Advanced knowledge of insurance coverage, concepts and claim resolution process
  • Intermediate proficiency with personal computers and Microsoft Office programs
  • Excellent written and verbal communication skills
  • Excellent organizational and interpersonal skills

SUPERVISORY RESPONSIBILITIES:

  • Supervises Claim Managers, Litigation Support and Claims Administrative Coordinators

PHYSICAL / ENVIRONMENTAL DEMANDS:

  • Job performed in a well-lighted, modern office setting
  • Occasional lifting/carrying (15 pounds or less)
  • Moderate travel
  • Prolonged sitting
  • Moderate stress with ability to work in a dynamic environment
  • Prolonged work on computer/PC

This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, fax) and/or the ability to perform repetitive motions and/or meet production standards to comply with the essential functions. Also, may require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week.

DISCLAIMER:

The information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.

 

Skills required

Medicare
Quality Management
Business Process Improvement
Claims
Finance
Regulatory Compliance
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Job ID: 1240/995

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Celebrating more than three decades of experience in physician services, we’ve grown from a small company established by emergency physicians to one of the largest integrated care providers in the country. Today, 20,000+ clinicians strong, we offer the highest quality staffing, administrative support and management across the full continuum of care, from hospital-based practices to post-acute care and ambulatory centers.

Collective success is the only true measure of a job well done. We steadfastly believe doing the right thing leads to better outcomes for all, so we forge genuine relationships among our team members, the facilities where they work and the communities they serve.

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