Senior Director, Claims and Legal

Overview

Premier Insurance provides management services to American Excess Insurance Exchange, RRG (AEIX), an excess professional liability reciprocal risk retention group, and operates an insurance brokerage providing insurance products and services to healthcare entities and providers nationwide. AEIX members pool their risks, and a majority of the members have internal claim management operations. Premier Insurance works with the member claims teams to manage complex, catastrophic, high value claims that are covered by the AEIX policies of insurance.

The purpose of this position is to operationalize and execute the mission of AEIX, to partner with forward-thinking healthcare leaders to safeguard assets, enhance patient safety, and inspire innovation, through collaborative and strategic claim management. This position will directly evaluate, monitor, and negotiate predominantly medical liability matters from notification to resolution. This position will manage the litigation process with broad authority requiring a high degree of technical complexity and be accountable for business results through cost-effective and timely resolution of multi-million-dollar claims.

This position will provide guidance and leadership regarding deployment of AEIX assets.

The Senior Director, Claims & Legal, must be a sophisticated, self-possessed individual who can balance working with different members and different personalities. This individual must be able to display a high degree of experience with an aptitude for complex, high value litigation. Diplomacy, sincerity, and a passion for vigorously defending claims must always be present. In addition to working directly with the AEIX membership, this position will work cooperatively with other Premier Insurance departments.

This individual will be required to prepare and present reports internally, to members and their representatives, such as TPA, defense counsel, and consultants. This position will be responsible for staying abreast of current industry trends and best practices and will provide updates to members and governance, as needed. In addition, this position will assist the Chief Legal Officer with legal review and editing and maintenance of contracts.

• Evaluating and monitoring liability matters, predominantly medical liability matters, from notification to completion;
• Demonstrating proactive intellectual curiosity regarding claim trajectory to provide solution-oriented ideas
• Review and assess member and attorney reports, expert opinions, medical records, and life care plan to develop strategies for resolution
• Identifying, retaining, and directing appropriate attorneys, experts, and consultants as necessitated by the facts of a particular claim;
• Working with member claims teams and their agents during the life of a claim to educate, strategize, and optimize best outcomes and drive down claims values;
• Understanding insurance policies and coverage determinations on a case-by-case basis;
• Understanding and following the litigation process in a way that allows for proactive decision making;
• Maintaining a caseload of high complexity and high severity claims, documenting files accurately and timely
• Monitoring business costs with a critical eye towards expense spend, mindfully directing the resolution of claims in a cost effective and timely manner;
• Making recommendations regarding appropriate indemnity reserves, settlement recommendations, and allocation of resources;
• Conducting annual claim reviews of AEIX member claim files and preparing summary reports of findings with recommendations for improvement opportunities, correcting deficiencies, and best practices;
• Identifying and coordinating web based and live educational sessions for AEIX members to encourage subject matter expertise and identification of valuable resources available to AEIX membership;
• Keeping abreast of developments in the hospital/medical liability sector including availing oneself of educational opportunities;
• Providing industry overviews and claim updates to clients as needed but including governance meetings.

Legal - 20%

• Substantive legal review of contracts, insurance…