Claims Manager

Major Responsibilities:

• Manages and executes the multi-million-dollar enterprise claims and litigation management program at assigned site(s). Site expert and resource for all claims-related subjects.
• In collaboration with site and medical staff leadership, executes system-wide program for developing and implementing risk reduction and financial loss prevention strategies. Disseminates claims and risk data reports for assigned site(s) for tracking/trending.
• Executes strategy for all professional and general liability claims to ensure the best resolution possible. Promotes best practices and consistent, effective claims handling in alignment with enterprise goals. Ensures all claims are appropriately financially reserved. Responsible for timely notice and communication for all claims insured under the Advocate Health reinsurance programs. Monitors all aspects of claims activity including in-person court attendance for trial management.
• Collaborates with Claims and Risk leaders in ensuring a coordinated, comprehensive, high quality enterprise Risk Management Education Program at assigned site(s).
• Executes all data entry in claims management system, ensuring accuracy and timeliness of claims data. Executes strategy and platform improvement initiatives.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• Bachelor’s degree in healthcare administration, law, or related field required.

Experience Required:

• Typically requires 5 years of claims, insurance, legal or risk management experience in a healthcare setting.

Licensure, Registration, and/or Certification Preferred:

• Certified Professional in Health Care Risk Management designation issued by the American Hospital Association (AHA) needs to be obtained within 1 year, or similar license or certification.

Education Preferred:

• Juris doctor of master’s degree in healthcare administration or related field preferred.

Experience Preferred:

• Legal, nursing or other clinical knowledge, background, and experience preferred.

Knowledge, Skills & Abilities Required:

• Demonstrated ability leading collaborative activities, chairing meetings and making presentations to physicians and executive leadership.
• Demonstrated ability to work and function in a complex corporate, system environment.
• Ability to communicate effectively with individuals of diverse backgrounds from all disciplines and levels of the organization. Must be comfortable and able to effectively and compassionately communicate with patients, claimants, and family members regarding difficult topics.
• Strong decision-making and critical thinking skills.
• Strong ability to manage multiple teams of people and projects simultaneously.
• Must be proficient in Microsoft Office (Excel, Access, PowerPoint and Word) or similar products.
• Demonstrated expertise in statistical/data analysis, data presentation, organizational ability, and attention to detail.
• Demonstrated ability to draft comprehensive reports and memos regarding all areas pertaining to the Risk function.

Physical Requirements and Working Conditions:

• Generally exposed to a normal office environment.
• Operates all equipment necessary to perform the job including computer use.
• Exposure to road and weather hazards during job-related trips.
• Must be able to sit, stand, bend, and lift frequently throughout workday.
• Must be able to walk sufficiently to cover entirety of site/facility.
• Must have clear speech, hearing and vision.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.