Sr. Professional Liability Medical Claims Manager *Remote

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* Remote* role at Providence Health & Services

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Join to apply for the Sr. Professional Liability Medical Claims Manager
* Remote* role at Providence Health & Services

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Description

Providence caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Providence is calling a Sr. Professional Liability Medical Claims Manager who will:

• Communicate with patients, claimants, caregivers, providers, leadership
• Review and analyze medical records, interview witnesses, assist with the discovery process and communicate with facility risk manager regarding evaluation and investigation
• Be responsible for writing insurance policy coverage letters
• Analyze insurance policy documents to address coverage
• Set appropriate indemnity and expense reserves
• Select appropriate medical experts for case review
• Develop a plan of action for assigned claims and update the claims file following all material changes in status
• Review and approve statements for services and take proper steps to pay vendors
• Inform Senior Manager Operations of large or complex claims and claims with potential for media exposure
• Report claims with potential excess exposure to excess insurers
• Ensure compliance with relevant claims reporting procedures and required regulations
• Work with defense attorneys specializing in defense of medical negligence claims
• Have direct responsibility to foster teamwork, operational excellence, and effective communication within the claims team, including other Claims Managers, Claims Reps and Claims Specialists
• Develop and document for each claim or lawsuit a plan of action for resolution by settlement, trial, or other means
• Maintain the electronic file including all material communication, correspondence, analysis, expert opinions, interview summaries and all other material documents in accordance with the Claims Policies and Procedures Manual

• Communicate with patients, claimants, caregivers, providers, leadership
• Review and analyze medical records, interview witnesses, assist with the discovery process and communicate with facility risk manager regarding evaluation and investigation
• Be responsible for writing insurance policy coverage letters
• Analyze insurance policy documents to address coverage
• Set appropriate indemnity and expense reserves
• Select appropriate medical experts for case review
• Develop a plan of action for assigned claims and update the claims file following all material changes in status
• Review and approve statements for services and take proper steps to pay vendors
• Inform Senior Manager Operations of large or complex claims and claims with potential for media exposure
• Report claims with potential excess exposure to excess insurers
• Ensure compliance with relevant claims reporting procedures and required regulations
• Work with defense attorneys specializing in defense of medical negligence claims
• Have direct responsibility to foster teamwork, operational excellence, and effective communication within the claims team, including other Claims Managers, Claims Reps and Claims Specialists

• Develop and document for each claim or lawsuit a plan of action for…