Maxonic maintains a close and long-term relationship with our direct client. In support of their needs, we are looking for an Risk Manager/Claims Specialist.
Job Description:
Job Title: Risk Manager/Claims Specialist
Job Type: Contract
Job Location: York PA
Work Schedule: Hybrid
Pay Rate: $ 93 Based on experience.
Description:
General Summary
Provides risk management services to System entities. Evaluates the risk of financial or property losses and arranges for appropriate insurance coverage for such losses. Oversee the claims process, including managing activities, documents, and files related to handling and settling claims, as well as ensuring that each claim is handled promptly, appropriately, and in accordance with company policy. Manages day-to-day operations of claims function and provide general oversight and direction of all litigation and claims activity. Assumes the duties and responsibilities of the Risk Manager in their absence.
Responsibilities for Internal Candidates
Duties and Responsibilities
Essential Functions:
Responds to questions concerning risk management and claims that may arise. Conducts and participates in Root Cause Analyses and risk assessments such as PRAs, FMEAs, etc. upon request and as needed.
Participates in the Accreditation/Risk Management on-call rotation.
Reviews event reports daily. As requested, assists the entity patient safety officer in the event of investigation and in decisions concerning regulatory reporting issues.
Conducts educational sessions on risk issues for the various entities as necessary.
Investigates allegations of inappropriate treatment/care which results in injury (or alleged injury) to a patient/visitor and determines next steps.
Drives proficiencies in claims processes and investigations to reduce litigation costs by tracking, reviewing, and analyzing newly litigated cases. Determines the complexity and value of litigated claims for possible resolution, attending trial as needed. Reviews and analyzes initial case assessment and legal strategy and assists in the development of litigation strategy.
Collaborates with leadership to develop reporting metrics (for example, reporting metrics packet) and develops reports and communicates results of current and potential litigation trends to leadership, including, but not limited to, communicating updates such as pre-trial reminders, daily trial updates, and summaries of cases where an increase in indemnity reserves is being requested, as well as any other critical updates.
Identifies, gathers, and preserves discovery items, or items requested by defense counsel that will assist with an investigation, related to existing or potential litigation.
Manages and overseas outside counsel on litigation, discovery matters, litigation costs, negotiations, and settlement agreements by identifying and assigning counsel to handle claims.
Reviews and approves outside counsel invoices to ensure billable hours are appropriate for each case and rejects incorrect invoices and follows up with outside counsel when there are questions with respect to such invoices.
Directs the preparation and maintenance of department reports. Prepares periodic reports for top management, as required.
Provides management services to the Company s reciprocal Risk Retention Group, and coordinates activities of governing board, attorneys, and consultants.
Common Expectations:
Maintains established policies and procedures, objectives, quality assessment, and safety standards.
Maintains appropriate records, reports, and files as required.
Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
Works collaboratively with Risk Management, Accreditation and Licensure, and key stakeholders to address organization risks.
Required for All Jobs:
Performs other related duties as identified.
Company has adopted and implemented a compliance program to support Company's values and standards for professionalism, integrity, and ethics.
Expected to support and meet the values and standards of the organization and the performance expectations of the job, the department, and the compliance program.
Company has adopted and implemented a privacy program to safeguard the patient information and the business and operational information of the organization. Expected to support and meet the values and standards of the organization to safeguard patient and business/operational information.
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
Physical Demands:
Standing - Occasionally
Walking - Occasionally
Sitting - Frequently
Reaching - Rarely
Talking - Frequently
Hearing - Frequently
Repetitive Motions - Occasionally
Eye/Hand/Foot Coordination - Occasionally
Travel Requirements:
Estimated Amount: - Some travel required within Company s geographic service area.
Qualifications for Internal Candidates
Qualifications
Minimum Education: Master s Degree Required or
Work Experience:
5 years Health care or insurance related experience. Required
Claims management or paralegal background experience. Preferred
About Maxonic:
Since 2002 Maxonic has been at the forefront of connecting candidate strengths to client challenges. Our award winning, dedicated team of recruiting professionals are specialized by technology, are great listeners, and will seek to find a position that meets the long-term career needs of our candidates. We take pride in the over 10,000 candidates that we have placed, and the repeat business that we earn from our satisfied clients.
Interested in Applying?
Please apply with your most current resume. Feel free to contact Raghav Pradhan (/) for more details.
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