Senior Medical Malpractice Claims Examiner

13 hours ago

Pasadena, United States Kaiser Permanente Full time
Remote from CA, OR, WA, CO. Working hours are PST. 
Kaiser Permanente is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location along with a review of current employees in similar roles to ensure that pay equity is achieved and maintained across Kaiser Permanente.

Job Summary:

Responsible for the administration of medical malpractice and other professional and general liability claims made during the course of conducting company business across the enterprise, having a material impact on legal reserves that are listed as a separate line item on the company's financial statements. The collective value of claims settled, as influenced by this job function, have direct implications for KPs bottom line. The resolution of these claims can also have ramifications for KPs reputation as well as potential regulatory involvement. Ensure claims are handled appropriately within the National Claims Guidelines and successfully resolved, including retention of outside defense counsel, in-house resolution, monitoring of legal fees, costs and settlement expenses, attendance at court proceedings, provision of claims analysis in leadership committees and identification of insurance coverage applicability.

Essential Responsibilities:
  • Provides comprehensive support on medical malpractice and related cases and claims brought against Kaiser Permanente. Together with the responsible attorney in the public and professional liability practice group, manages the defense and disposition of professional liability claims and litigation.
  • Claims Management: Ensures compliance with internal PPL policies for management, handling & reporting of moderately complex to complex claims.
  • Investigates pre-suit claims related to medical malpractice, professional liability, general liability, coverage/benefit and some business practices and disposition thereof, if appropriate, including selection and retention of medical experts and negotiation with claimants and/or their attorneys.
  • Updates and maintains claims databases; inputs into national claims-related databases.
  • Analyzes and prepares responses to discovery requests (including interrogatories and responses to requests for production of documents).
  • Attends significant depositions, hearings, settlement conferences and trials.
  • Retains and directs defense counsel in the event that early disposition is not appropriate or possible.
  • Monitors status of cases and outside counsel compliance with litigation guidelines. Participates with outside counsel in the development of strategic case management and action plan steps.
  • Keeps KP Lead Claims Counsel updated on all significant matters or legal developments that arise within incumbents claims roster.
  • Fiscal Management: Sets reserves based upon the total loss exposure and the probabilities of different outcomes for claims disposition. Establishes and conducts quarterly review of reserve information.
  • Insurance Policy Management: Ensures completion and submission of appropriate reports to Risk Finance on matters of potential Excess Insurer intervention.
  • Management Reporting: Compiles requested information for management reporting; updates and maintains claims calendar; maintains claim files.

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