Claims Analyst II

Overview

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

How you belong matters here. We value our employees' differences and find strength in the diversity of our team and community.

Now hiring Claims Analyst II!

Investigates, evaluates, and negotiates more severe and complex claims and litigation to a successful resolution and in compliance with company quality standards; primarily medical malpractice but may include such claims as arson, fraud, excess/umbrella, Directors and Officers, liability, products and completed operations, premises bodily injury and property damage exposures of a more severe and complex nature. Maintains claims database documentation, appropriate reserving and case strategy. Prepares claim reports, and educates organization about risk issues identified through claims data. Attends and participates in mediation of claims or litigation, facilitates and manages PHS response to discovery requests, communicates updated claims information to insurers as appropriate. Under the supervision of the risk director and risk attorney, directs PHS participation in defense of claims and litigation. Identifies and manages actual or potential sources of financial loss arising from: 1) injury to the person, property, or reputation of PHS, patient, volunteers, and staff, or (2) failure to comply with applicable laws or regulations

Ideal Candidate:

Ideal Candidate has 4 years relevant experience in managing complex medical malpractice claims.

Full Time - Exempt: Yes Job is based Rev Hugh Cooper Admin Center Work hours: Days

Qualifications

• Bachelors degree or equivalent experience required.
• Four years relevant experience in managing complex medical malpractice claims or five years relevant experience in clinical provision of healthcare required.
• Requires knowledge of legal issues, data management and interpretation, and effective communication skills

 

Responsibilities

*In conjunction with the risk director and risk attorney, responsible for the handling of all aspects of a claim file from beginning to conclusion, including the investigation, , determination of liability, confirmation of coverage, assessment of damages, carrier/excess reporting and negotiation and settlement of claims, representing the interests of PHS.*Preparation of discovery response plan - interrogatories, requests for production, subpoena, motions: Review, analyze, research and prepare responses for discovery. Gather, organize and index requested documents including electronic discovery. Conduct an analysis of scope, facts and information relevant to the case or to a formal discovery request. *Effectively utilize the claims information system to maintain all relevant data. maintain a diary/task system to periodically review all claims for status of investigation, assessments of liability, documentation of damages, adequacy of reserves, evaluation of expert witnesses, documentation of recent developments and current plan for claim resolution*Responsible for the coordination of defense strategy among all named defendants, regardless of coverage and proactively drive claim strategy forward to ensure successful outcome. Coordinate legal defense with assigned attorney, manage and coordinate investigation and discovery process, review attorney invoices; monitor counsel for compliance with PHS requirements. *Participate in claims conferences and mediations with risk director/risk attorney, or defense counsel and consultants to focus the efforts of all concerned parties on the assessment of liability and development of appropriate litigation strategy.*Investigates, evaluates, and responds to customer (members, patients, patient relatives and visitors) complaints concerning all aspects of care delivery and business operations throughout PHS, evaluates, and initiates business office account adjustments charged against Risk Managements professional or general liability retention accounts.*Manages relationships and provides support for internal and external customers. Serves as primary source of contact and support for employees named or involved in claims/lawsuits. Maintains cooperative working relationships with other departments in order to respond quickly to internal and external customers. Actively participates in problem solving and problem resolution in accordance with PHS policy, state and federal statues, and regulatory agency requirements

Benefits

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Learn more about our employee benefits.

About Presbyterian Healthcare Services

Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 13,000 employees - including more than 1200 providers and nearly 3,500 nurses.

Our health plan serves more than 640,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Inclusion and Diversity

Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Offer Disclaimer

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs. Compensation decisions are dependent upon the facts and circumstances of each offer.

Maximum Offer

USD $47.83/Hr.

Salary : $48