What are the responsibilities and job description for the 01 Manager Risk Claims position at Southeast Georgia Health System Inc?
Claims Management Oversight.
- Lead the investigation and evaluation of professional, general, and other liability claims under the Health System’s insurance program.
- Engage with Health System team members, outside counsel, patients, and claimants as needed.
- Review and analyze medical records, conduct witness interviews, and support the discovery process.
- Draft and review correspondence with insurers and analyze insurance policy documents to determine coverage.
- Establish appropriate indemnity and expense reserves.
- Collaborate with the Legal Department to select medical experts for case reviews.
- Develop and implement action plans for assigned claims and update claims files based on material changes.
- Review and approve service statements and take necessary steps to ensure payment.
- Report claims with potential excess exposure to excess insurers.
- Ensure compliance with claims reporting procedures and relevant regulations.
Documentation Management.
- Ensure comprehensive and accurate documentation for each claim or lawsuit, including communication, correspondence, analysis, expert opinions, and interview summaries.
Claims Resolution.
- Work closely with the Assistant General Counsel – Litigation & Risk to negotiate settlements when appropriate.
- Monitor trials, report to regulatory agencies as required, and close files according to internal policies and procedures.
- Facilitate reporting to the National Practitioner Data Bank and state agencies as needed.
- Contribute to departmental projects aimed at enhancing procedures and improving departmental efficiency.
Risk Reduction:
- Provide feedback, recommendations, and evaluations on litigation trends to inform operational policies and procedures.
- Offer insights for quality and patient safety projects to appropriate leaders, aiming to reduce future claims.
