What are the responsibilities and job description for the Claims Examiner position at Salem Health Hospitals & Clinics?
Description
Location Site: Salem Hospital Main Campus
Department: SH Risk & Safety Management
Position Type: Full Time
Start Time: 8:00
Pioneering healthcare since 1896, Salem Health is a top workplace offering highly competitive pay where you can make a difference in the lives of those in the community where you live. Through incorporation of Lean driven principles, staff are able effect change in the organization to solve problems, and drive continuous improvement.
As an employer of choice, we are devoted to assuring that we provide a safe, healthy, and patient-centric workplace, while keeping staff wellbeing and satisfaction top of mind.
We invite you to learn more about our wonderful community: There’s something about Salem, Oregon!
Your Role With Us:
As a Claims Examiner at Salem Health, your role will focus on the management of all insurance claims, particularly professional and general liability claims, including the oversight of lawsuits, claims, and potential claims. You will evaluate potential exposure, liaise with legal counsel, and ensure timely reporting of incidents to the appropriate insurance carriers. By negotiating and settling claims, you will work to avoid prolonged and costly litigation. Also, you will conduct thorough in-house investigations, which include reviewing medical records, interviewing staff, gathering necessary information, and assessing liability and exposure. Additionally, you will be responsible for determining indemnity and expense claim reserves, maintaining up-to-date diaries for open claims, and formulating plans for claim disposition. In collaboration with the department director and defense counsel, you will assist in case strategy development and attend settlement conferences, mediations, and trials as necessary. Your role will also involve maintaining accurate claim documentation, ensuring compliance with the Claim Manual, and ensuring proper updates are provided to excess carriers. You will analyze patient safety reports to identify trends and recommend risk control techniques, collaborate with Patient Safety and Patient Advocates on disclosures, and ensure compliance with the Safe Medical Device Act and Medicare, Medicaid, and SCHIP Extension Act reporting requirements to CMS.
Total Rewards Offerings:
Salem Health's comprehensive benefits package prioritizes your mental and physical health, financial stability, family obligations and professional growth.
- Relocation assistance available for qualified positions
- Full comprehensive medical, dental, and vision plans
- Basic and voluntary life insurance
- Short and long-term disability
- Live Well Wellness Program
- Employee Assistance Program (EAP)
- 401(K) retirement plan with employer contributions.
- Generous paid time off (PTO) accrual and holiday pay
- Onsite fitness center with 24/7 badge access
- Education assistance program
- Public service loan forgiveness (PSLF) eligible employer https://studentaid.gov/
- Food and drink discounts in the cafeteria
- Impressive discounts offered by Nike, Adidas, Carhartt and others
Background/Expertise:
- Bachelors Degree strongly preferred - Clinical or health care degree PREFERRED.
- Minimum five (5) years experience in managing claims and lawsuits preferably healthcare entity, working in a legal office, or comparative work experience REQUIRED.
- Effective investigational skills.
- Thorough understanding of liability insurance, claim related legal concepts.
- Bilingual (English/ Spanish) PREFERRED.
Salem Health Hospitals and Clinics is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, genetic information, or any other status or condition protected by law.
Salem Health Hospitals and Clinics is committed to providing access, equal opportunity and reasonable accommodation for applicants. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact my.recruiter@salemhealth.org
