Claims Specialist
Company: Christus Health
Location: Irving
Posted on: June 21, 2022
Job Description:
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%). Location will
be Irving System Office. Serves as liaison to all affiliated health
care centers in the investigation, resolution and defense of
claims.
- 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.Requirements:
- BSN required
- RN licensure required
- Three (3) to Five (5) 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
- Organizational skills, Leadership and problem solving
skills
- Computer literacy, PowerPoint/Excel skills a plus.
- Demonstrated, organizational and interpersonal skills
- Enjoys teaching and public speaking.
- RN required
- Paralegal Certificate Preferred. JDs will be
considered.
- Adjuster licensure and/or CPHRM certification a plus
Work Type:Full Time
Req. No43610Job TitleClaims SpecialistMarketCHRISTUS System
OfficeCategoryGeneral OperationsTravelOccasional Overnight Travel
Up To 20 PercentFacilityCHRISTUS Corp Irving Offices 919 and 909
BuildingsAddress919 Hidden Ridge
Irving, TX 75038
USView On A MapView Other LocationsTypeFULL TIME
Keywords: Christus Health, Irving , Claims Specialist, Other , Irving, Texas
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