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 Health Plan is calling a General Liability Claims Manager, Healthcare who will:
- Be responsible for day-to-day oversight of general and professional liability claims in accordance with the System's claims program policies and procedures and within an assigned Region or scope of responsibility
- Be responsible for investigating, evaluating and managing professional and other liability claims against the organization as assigned
- Maintain up-to-date and accurate claims files, including summaries, action plans, and claims status in the claims data management software
- Coordinate with facility leadership, risk managers, defense counsel, and others; ensuring compliance with relevant claims reporting procedures and required regulations
- Provide feedback and recommendations to the Management on evaluations, litigation trends, department policies and procedures, system-wide claims and litigation processes, and appropriate System risk management issues
- Be directly responsible for fostering teamwork, operational excellence and effective communication within the claims team, including other Claims Managers, Claims Technicians and Claims Specialists
Essential Functions:
Investigate, Evaluate, and Manage Professional, General and other Liability Claims under the PSJH Insurance Program:
- Review and analyze medical records, interview witnesses, assist with the discovery process and communicate with facility risk manager regarding evaluation and investigation
- In collaboration with facility risk management, set appropriate indemnity and expense reserves including documentation of jury verdict research or similar analysis of exposure
- 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 Management of large or complex claims and claims with potential for media exposure
- Report claims with potential excess exposure to excess insurers
Maintain Complete Documentation for Each Matter:
- 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
- Maintain up-to-date claims status and actions plans on all Potential Claims, Claims and litigated matters in the claims data management software
Resolve Claims In Accordance with Policies and Regulations:
- Negotiate settlements
- Monitor trials
- Close files in accordance with internal policies and procedures and facilitate appropriate reporting to NPDB and state agencies
- Participate in department and claims team projects as assigned to develop and improve procedures, policies; to improve efficiency of department work; and to assist the Group Vice President and Director of Risk & Claims as needed
Provide Input to Reduce Risk:
- Provide feedback and recommendations to Management regarding claims trends and appropriate risk management responses
- Provide input for quality and patient safety projects, through the Risk & Integrity Services division and Risk, Claims, & Insurance department
Providence welcomes 100% remote work for applicants who reside in one of the following States:
- Alaska
- Washington
- Oregon
- Montana
- Idaho
- California
- New Mexico
- Nevada
- Texas
Required qualifications for this position include:
- Bachelor's Degree in Business Administration, Finance, or a related discipline -OR- a combination of equivalent education and experience
- 5+ Years of experience in any of the following areas of focus / specialty:
- General Liability Claims Processing
- General Liability Claims Management
- General Liability Legal Experience (E.G. Paralegal, Etc.)
- Healthcare Risk Management
- General Risk Management
- Insurance General Liability Claims Handling
Preferred qualifications for this position include:
- Experience with a mix of general liability claims, including at least 10 claims with significant bodily injury and experience with STARS software
- Healthcare experience
- Certified Professional Healthcare Risk Management (CPHRM)
Salary Range by Location:
- AK: Anchorage: Min: $44.24, Max: $70.03
- AK: Kodiak, Seward, Valdez: Min: $46.11, Max: $73.00
- California: Humboldt: Min: $46.11, Max: $73.00
- California: All Northern California - Except Humboldt: Min: $51.74, Max: $81.90
- California: All Southern California - Except Bakersfield: Min: $46.11, Max: $73.00
- California: Bakersfield: Min: $44.24, Max: $70.03
- Montana: Except Great Falls: Min: $35.62, Max: $56.38
- Montana: Great Falls: Min: $33.74, Max: $53.42
- Idaho: Min: $39.36, Max: $62.32
- New Mexico: Min: $35.62, Max: $56.38
- Nevada: Min: $46.11, Max: $73.00
- Oregon: Non-Portland Service Area: Min: $41.24, Max: $65.29
- Oregon: Portland Service Area: $44.24, Max: $70.03
- Texas: Min: $33.74, Max: $53.42
- Washington: Western - Except Tukwila: Min: $46.11, Max: $73.00
- Washington: Southwest - Olympia, Centralia & Below: $44.24, Max: $70.03
- Washington: Tukwila: Min: $46.11, Max: $73.00
- Washington: Eastern: Min: $39.36, Max: $62.32
- Washington: South Eastern: Min: $41.24, Max: $65.29
Why Join Providence?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About Providence
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected.
Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.
Requisition ID: 318534
Company: Providence Jobs
Job Category: Financial Transactions
Job Function: Health Plans Services
Job Schedule: Full time
Job Shift: Day
Career Track: Business Professional
Department: 4008 SS RIS
Address: WA Spokane 9 E Ninth Ave
Work Location: Providence Svcs-Spokane
Workplace Type: Remote
Pay Range: $See Posting - $See Posting
