Claims Analyst or (Senior) Claims & Patient Safety Specialist
$73,050–$156,958 year
RemoteCalifornia, United States
Job Summary
Respond to first notice of potential claims from policyholders, gathering preliminary information and providing appropriate advice. Collaborate with the Claims team to identify coverage issues, develop negotiation strategies, and manage file status, reserves, and legal landmarks. Obtain and review records, interrogatories, and reports; coordinate discovery with defense counsel and prepare correspondence with policyholders and attorneys. Submit incident and claim files for opening and manage closures within authority limits. Exercise strong judgment in settling cases and develop indemnity and expense reserve recommendations above defined authority levels. Study trends in the medical malpractice industry, share relevant court cases, and participate in seminars and Board meetings. For Specialist and Senior levels, provide specialized risk management services, analyze data to present evidence-based information, conduct claims prevention surveys, manage unanticipated patient harm through the RESTORE program, and mentor less-experienced staff.
Required Qualifications
- A Bachelor's degree (BA/BS)
- A valid driver's license
- A minimum of five (5) years of experience handling medical professional liability claims or professional-level experience in the legal industry
- A minimum of seven (7) years of experience as a medical professional liability claims representative, healthcare risk manager or similar experience in defense of medical professional liability or risk management/patient safety field
- A minimum of ten (10) years of experience as a medical professional liability claims representative, healthcare risk manager or in a similar role involving the defense of medical professional liability matters or risk management/patient safety work
- Experience handling complex claims or risk matters
- Exercise independent judgment
- Advising stakeholders
- Contributing to team knowledge or process improvement
- Proficiency in medical terminology
- An understanding of clinical systems
- Knowledge of hospital policies and procedures, and governmental healthcare regulations
- Ability to analyze medical records and quality issues
- Advanced claim judgment
- The ability to manage complex matters with limited oversight
- Readiness to serve as a technical resource for others
- Experience in the handling of medical professional liability claims
- A solid understanding of Patient Safety Risk Management (PSRM) services and products
- The ability to address general PSRM questions or refer to the appropriate discipline
- A demonstrated customer service focus with all levels of internal and external stakeholders
- Skilled at managing multiple priorities with great attention to detail, within time-sensitive deadlines
- An inquisitive analytical thinker with good judgement, professional initiative, and strong research skills
- Excellent written, verbal, and interpersonal communication skills
- Digital fluency, comfortable in a range of virtual environments
- Proficiency with office software including Word, Excel, Power Point, Windows, Teams, Sharepoint, CoPilot, and paperless document management programs
- Remote work capability
- Preference for candidates located in Southern California or adjacent states
- Limited travel to main office in Oakland, CA
- Some travel from time to time, including overnight stays
Desired Qualifications
- A Certified Professional in Healthcare Risk Management (CPHRM) designation
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.