Sr. Professional Liability Medical Claims Manager *Remote*

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. Professional Liability Medical Claims Manager 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 for applicants who reside in the United States. Note: Providence is not currently considering applicants who reside in the following States:**