Claims Manager - Risk Management Department

at  Franciscan Missionaries of Our Lady Health System

Responsible for day-to -day management of the professional and general liability lawsuits and claims against the hospital and its affiliated entities. Actively works with in-house and outside counsel in investigating lawsuits and claims, developing defense strategy and evaluating the monetary value of the claim, and will negotiate settlements with the approval and direction of in-house legal counsel or administration.

Claims Management

• Works with counsel to monitor claim activities, recommending action including settlements.
• Acts as a liaison between counsel, insurance companies and third parties on claim-related issues
• Completes claim updates prior to quarter end and reviews loss runs for reporting to insurance carriers.
• Directs and manages investigative activity related to lawsuits and reports to proper authorities
• Sets accurate reserves on all claims and manages claim in accordance with set reserves.

Relationships/Partnering

• Acts as system representative for claim-related issues and responds to medicolegal issues from physicians, managers, nurses, and administrative personnel.
• Participates on various hospital committees in an effort to lend risk management oversight to procedures.
• Works with employees, managers, attorneys and insurance companies to assure best outcomes in litigation.

Education and Benchmarking

• Educates hospital personnel in an effort to reduce likelihood of litigation
• Trends departmental claims data with national benchmarks in effort to control costs for organization
• 7 years in nursing, admin., healthcare, or law
• Bachelor’s Degree or RN diploma
• If RN current Louisiana license or certification in Risk Mgt or Insurance

Please refer the Job description for details