Medical Claims/Risk Mgr

4 weeks ago

Hartford, United States Hartford HealthCare Full time

Description

Job Schedule: Full Time

Standard Hours: 40

Job Shift: Shift 1

Shift Details:

Work where every moment matters.

Every day, approximately 38,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network.

The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.

With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

Position Summary:

Manages a robust caseload, from inception to closure, of Hartford HealthCare's claims and suits through HHC's Legal Department. Responsible to assist in the implementation, monitoring and maintaining of Hartford Healthcare's claim insurance program (the "Captive"), which consists of professional liability, general liability, auto liability and workers' compensation liability claim management for program insureds. Assists in maintaining financial security of said insurance program while fostering its growth by handling medical professional liability claims/suits to conclusion.

Candidate will have working knowledge of insurance coverage, medical and legal terminology and application. Builds a strong foundation for each claim in order to apply coverage properly, determine liability, and make claim settlements as necessary within authority. Requires independent judgment in determining when to consult claims management when confronted with non-routine situations or problems. Possesses the ability to work in a fast-paced, growing and changing environment. Consistently exhibits behaviors and communication skills consistent with Hartford Healthcare's core values. Full time, in-office position, located in Hartford.

Position Responsibilities:

* Interacting with claimants, insureds, attorneys, risk management and underwriting.
* Verifying coverage information and/or resolving coverage issues.
* Gathering loss information and evaluating a variety of liability exposures, case value and reserve accuracy, which may include professional liability, general liability, auto liability and workers' compensation liability
* Presenting complex litigation, reserve and strategy recommendations to claims leadership if necessary.
* Attending defense meetings, settlement conferences, trials and mediations as directed.
* Directing outside counsel, developing and monitoring defense budgets, applying legal billing guidelines in analysis of invoices, and reviewing and approving defense charges.
* Directing and implementing defense tactics and strategies.
* Promptly communicating with Claims Leadership regarding areas where quality improvement activities and/or risk mitigation initiatives affecting Hartford Healthcare may be warranted.

Contributing and assisting in the implementation of a wide range of initiatives brought forward by the Claims Team and HHC Leadership.

Qualifications

Education:

* Bachelor's Degree, preferably a JD or insurance adjuster license

Experience:

* Three years insurance claim management/risk management handling a variety of liability claims including medical malpractice, from start to closure, including initial investigation, establishing reserves, and negotiation of settlements
* Proven ability to mediate and negotiate settlements is preferred.

Licensure, Certification, Registration: CT State Multi-Line Casualty License or equivalent Insurance Industry Certifications. LEAN certification is preferred.

Knowledge, Skills and Ability Requirements:

* Dependable, self-motivated team player with a strong work ethic
* Active Listener who can exhibit empathy to claimants
* Demonstrated history of proactive claims management
* Demonstrated knowledge of the healthcare and insurance industries including insurance coverage, claim handling principles, insurance/legal statutes, medical and legal terminology, and regulatory environment
* Must possess strong analytical, problem-solving and organizational/time-management skills
* Knowledge of Microsoft Office applications and ability to learn new software programs
* Excellent oral and written communication and interpersonal skills for negotiations and for all levels of management
* Provide a high degree of customer service.

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge - helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.

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