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Director, Claims Management

TeamHealth • Knoxville, TN

Posted 6 days ago

Job Snapshot

Full-Time
Degree - 4 Year Degree
Healthcare - Health Services
Health Care

Job Description

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.

Job ID: 1240/995
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