What are the responsibilities and job description for the Senior Claims Specialist - Risk Management position at ECU Health?
ECU Health
About ECU Health
ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.
The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Childrens Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.
Position Summary
This position is responsible for investigating, documenting, evaluating, and resolving allegations related to allegations, claims or lawsuits brought against ECU Health, an ECU Health entity or one of its team members or insureds or one of its entities is a Plaintiff in a cause of action. These allegations, claims and/or lawsuits can arise out of general liability, professional liability, employment practices, Title VII complaints, fiduciary and other specialized allegations within the organization. Some investigations will be completed under the direction of legal counsel. Communicate findings and resolve/settle claims and/or lawsuits within established guidelines.
During investigations, should the role identify operational issues, they will disseminate these findings to leadership and Senior Executives for review and follow up. Responsible for management of the full life cycle of a claim or lawsuit including initial intake, evaluating coverage and reserving, completing investigation and discovery and resolving the matter.
Minimum Requirements
Four-year college degree (preferred or higher). However, five years of related experience can substitute for two years of the required education and seven years of related experience can substitute for four years of required education.
Four years of experience in healthcare, legal, risk management, human resources, investigation or business setting.
Associate in Risk Management (ARM) or Certified Professional in Health Care Risk Management (CPHRM) preferred.
Other Information
It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.
Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.
We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicants qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.
About ECU Health
ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.
The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Childrens Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.
Position Summary
This position is responsible for investigating, documenting, evaluating, and resolving allegations related to allegations, claims or lawsuits brought against ECU Health, an ECU Health entity or one of its team members or insureds or one of its entities is a Plaintiff in a cause of action. These allegations, claims and/or lawsuits can arise out of general liability, professional liability, employment practices, Title VII complaints, fiduciary and other specialized allegations within the organization. Some investigations will be completed under the direction of legal counsel. Communicate findings and resolve/settle claims and/or lawsuits within established guidelines.
During investigations, should the role identify operational issues, they will disseminate these findings to leadership and Senior Executives for review and follow up. Responsible for management of the full life cycle of a claim or lawsuit including initial intake, evaluating coverage and reserving, completing investigation and discovery and resolving the matter.
Minimum Requirements
Four-year college degree (preferred or higher). However, five years of related experience can substitute for two years of the required education and seven years of related experience can substitute for four years of required education.
Four years of experience in healthcare, legal, risk management, human resources, investigation or business setting.
Associate in Risk Management (ARM) or Certified Professional in Health Care Risk Management (CPHRM) preferred.
Other Information
- 36 hours a week
- Monday - Friday (8 am - 5 pm)
- Hybrid ()
- Required to work on-site, when needed
- Great Benefits
It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.
Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.
We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicants qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.
