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Dartmouth-Hitchcock Workforce Readiness Institute Director Claims Management (FT) in Lebanon, New Hampshire

Director Claims Management (FT)

Lebanon, NH, USA

New

Professional/Management

Post Date May 24, 2021

Requisition # 21000226

Full time on-site based in Manchester NH , with flexibility for some work at home

Purpose:

Develops, implements, leads and maintains a comprehensive system-wide Claims Management program. Organizes, and administers the D-HHS Claims Management Program and coordinates all program activities. Supports Risk Management with identification risk trends and data to enable development of risk management initiatives.

Key Responsibilities:

  1. Oversees and implements a comprehensive Claims Management Program, and delineates claims management scope, authority, responsibilities, and policies.

  2. Provides guidance on insured claims for medical professional, general liability, employment liability and cyber liability claims.

  3. Investigates, evaluates and resolves medical professional, general liability, employment liability and cyber liability claims for assigned hospitals, clinics and insured providers.

  4. Establishes staffing and resource needs to operationalize a system-wide Claims Management program.

  5. Assists Risk Management and other hospital personnel in responding to risk-related incidents, as requested.

  6. Evaluates financial exposure, sets financial reserves and reports upstream when exposures exceed personal authority.

  7. Assure adherence to current diary system to review progress of claims and litigation and adequate documentation of claim development and resolution.

  8. Train and develop senior personnel and medical staff on the role of claims management.

  9. Respond and communicate directly to the system’s Chief Legal Officer, brokers, re-insurers, risk managers, CEO’s and patient families on claims-related matters.

  10. Develops andmaintains awrittenclaimsmanagementplan.

  11. Assures adequate adherence to reporting requirements of reinsurers and excess carriers.

  12. Coordinate efforts of panel counsel and identify qualified firms to add to panel.

  13. Oversee outside counsel’s work product and fees, the assignment of counsel, negotiation and evaluation of claims and litigation.

  14. Create and encourage high performance, teamwork and collaboration between team members, other departments and organizational clients.

  15. Directs workloads and requests made to the Office of Claims Management to ensure alignment with strategic initiatives of the organization.

  16. Develops Board summary reports of claims and claim trends, claim outcomes and program performance. Provide representative comparative data to Board to reflect program performance with other programs.

  17. Works with various boards, committees, management, and care providers to develop common expectations and understandings for the risk management and captive insurance programs.

  18. Review claims and incident data and interpret statistics to identify trends of emerging liability exposures. Keeps abreast of national trends in claims and defense of claims.

  19. Establishes methods, policies, and protocols to reduce and minimize allocated loss and adjustment expenses while maintaining values and directives of the organization.

  20. Coordinate and conduct quarterly claim reviews with departments, medical staff, and administration.

  21. Provides input into institutional decision-making and goal setting.

  22. Keeps abreast of any changes to legislation and regulations pertaining to insured claims.

  23. Budget, oversee and manage claims related expenses. Participate in budget development for Office of Claims Management.

  24. Performs other duties as required or assigned.

Minimum Qualifications:

  • Bachelor’s or Master’s degree, with at least 10 years of claims management and program leadership experience in the field of professional liability claims. JD or healthcare background preferred. Litigation and Risk Management experience a plus.

  • Strongknowledge of healthcareclinicalfundamentals,risk financing, healthcare risk managementandclaims management fundamentals.

  • Demonstratedleadership skillsincluding excellentoral and writtencommunication skills.

  • Advanced ability to present complex factual, medical and legal concept in thorough but concise manner.

  • Openness to growth and learning in a collaborative team environment, consistent with the goals and principles that guide the organization.

  • Ability and desire to function both collaboratively and independently.

  • Leadership acumen and experience; someone who can be innovative and function as a change agent.

  • Computer skillsandknowledge of applicablesoftware programs, including Microsoft suite of products.

  • Strong history of positive and cooperative relationships with senior leaders and physicians.

  • Abilitytoworkwithdiverse populations.

  • Flexibilitywith schedule.

  • Willingness to travel up to 30% of the time.

Required Licensure/Certification Skills:

  • Certified Professional in Healthcare Risk Management (CPHRM) and/or

Associate in Risk Management (ARM) preferred

  • Claim adjustor license-New Hampshire
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