Finance and Accounting Job In Tyler, Texas
Claims Specialist - Risk Finance
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Tyler, Texas 75701 Type of Facility: Hospital
Summary:
A CHRISTUS Regional Claims Specialist represents CHRISTUS Health and its facilities and providers and provides support to the Vice President of Litigation, the other Regional Claims Specialist and the Claims Team in the investigation, management, resolution and defense of claims, appeals, arbitrations or any other form of disputes. The duties vary including support of matters in pre-litigation and active litigation. Other legal work involves management of subpoenas, court appearances, mediations and trial appearances. Travel is a requirement (25-30%). Serves as liaison to all affiliated health care centers in the investigation, resolution and defense of claims.
Responsibilities:
- Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
- Provides support to the Vice President of Litigation, other Clinical Regional Claims Mangers and the Claims Team in the investigation, management, resolution and defense of liability events, claims, appeals, arbitrations or any other form of disputes.
- Evaluates and investigates patient and claimant complaints and demands and communicate recommendations for handling. Investigation includes, at times, on site interviewing of providers.
- Prepares privileged work product reports containing with clinical analysis regarding same and provides recommendations to the team for handling.
- When appropriate, negotiates settlements within designated authority, prepare settlement agreements using language of settlement agreements approved by the CHRISTUS Vice President of Litigation.
- Attends depositions, trials, hearings (as needed) and mediations. Negotiates negotiate settlements at mediation or directly with claimant or plaintiff’s counsel within designated authority. Drafts settlement agreements. Analysis of MMSEA issues.
- Identifies and evaluates trend and report analysis of quality and risk issues to assist in reducing the frequency of preventable adverse occurrences. Prepares presentations to facility leadership concerning trends and recommendations for improvement.
- Investigates all assigned Events, UPLE, Injured Asserts, Attorney Asserts, Medical Review Panels and Suits.
- Retains oversight of defense of claims interacting with defense counsel and defense teams.
- Recommends reserves and adjustments to same indicated by any follow-up investigation.
- Provides liability analysis and investigative support to defense counsel on commencement of litigation.
- Prepares status reports or other presentations relative to active claims based on regional assignments.
- Monitors trials, mock trials, jury studies and depositions and provides analysis and recommendations regarding litigation management to the CHRISTUS Vice President of Litigation.
- Monitors and participates in MMSEA compliance and reporting with the support of internal and external counsel.
- Monitors Outside Counsel compliance with guidelines and billing requirements.
- Interacts regularly with external attorneys related to the oversight and management of claims and all matters in litigation.
- Coordinates, Plans and Participates in facility claims reviews.
- Participates in Teaching events across the system as needed including teaching nursing residents on matters related to legal claims.
- Participates in risk management surveys of facilities.
- Must have organizational skills, Leadership, and problem-solving skills.
- Must have computer literacy, PowerPoint /Excel skills a plus.
- Must have demonstrated, organizational and interpersonal skills.
- Enjoys teaching and public speaking.
Job Requirements:
Education/Skills
BSN required.
Experience
- Three to Five years in a health care setting with exposure to some combination of clinical care, risk management or operations.
Some legal experience (i.e., Paralegal, Legal Nurse Consultant) Preferred.
Licenses, Registrations, or Certifications
- RN required.
- Paralegal Certificate Preferred. JDs will be considered.
- Adjuster licensure and/or CPHRM certification a plus.
Work Schedule:
5 Days - 8 Hours
Work Type:
Full Time
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CHRISTUS Health is an international Catholic, faith-based, not-for-profit health system comprised of more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures.
Sponsored by the Sisters of Charity of the Incarnate Word in Houston and San Antonio and the Sisters of the Holy Family of Nazareth, the mission of CHRISTUS Health is to extend the healing ministry of Jesus Christ.
To support our healthcare ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on staff who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.
EXTENDING THE HEALING MINISTRY OF JESUS CHRIST
We are inspired by our mission, vision and core values to deliver compassionate, high quality health care, improving the health of the communities we serve. Above all, we are committed to providing our customers and their family members with a truly unique healing experience, one that embodies our values and respects the dignity and worth of each person. Creating a health care system that is truly excellent in all areas is an ongoing effort.