Claims Consultant | Risk Finance and Insurance Services

DESCRIPTION:

Provide key system role in professional and general liability, workers compensation and employers liability claims review, investigation, management and disposition, including financial mitigation of indemnity payment and claim defense costs and management of System reputation Will work under the guidance of Senior Claims Managers, Senior Claims Consultant, Director of Insurance, and Vice President, to learn and develop the skills necessary for more independent work and decision making.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Conducts internal investigation, negotiation, and resolution of asserted professional and general liability, workers compensation and employer's liability claims by patients, their attorneys or representatives.
• Oversees and coordinates external investigation and resolution of claims, notices of intent and lawsuits and acts as a system representative of HFHS in cases before the courts, pretrial/settlement conferences, workers compensation bureau and trials.
• Reviews and analyzes facts, medical records and medical opinions. Prepare statistical, financial and factual reports for audit and actuarial studies. Provide status reports to department chairmen on claims exposure.
• Tracks case files and claims information which may typify trends or causal relationships for risk management analysis and provides period in-service education presentations and prepare periodic file summaries for claim documentation and presentation to HFHS Claims Review and Adjudication Committee or similarly constituted internal review committees and communicates progress/activity with supervisor with emphasis of trends and quality improvement. Inputs case information and updates information in Risk Finance and Insurance Services database.
• Builds and maintains positive partnership with all office personnel.
• Develop liaison relationships with System Risk Managers, Department and Division Heads, Medical Directors, treaters and system employees and managers while assisting them in crisis management, risk reduction and/or mitigation and other general related risk issues.
• Manage & advise on issues & concerns regarding stolen property and accidents within our fleet vehicle program, which also includes valet and parking services
  
  
  
  • Determine our liability;
  • Communicate with 3rd party insurance companies;
  • Monitor our insurance carrier to assure accurate reporting and resolution.
  
  
  
  
• Control and manage vendor payments
  
  
  
  • Examine defense firm billings and submit for payment;
  • Manage System wide insurance premiums, evaluate and pay;
  • Complete and file all required forms with workers compensation bureau
  • Submit surety bond payments and renewals.
  
  
  
  
• Provides support to all HFHS staff regarding receipt of subpoenas
  
  
  
  • Liaison among witnesses, attorneys and law enforcement who issue subpoenas;
  • Provide advice to physicians/other staff on process of being served.