Director Claims
Location:
Nashville , Tennessee
Posted:
November 23, 2017
Reference:
10201-22848
HCA, a Fortune 100 company with more than 200,000 employees, is one of the nation's leading providers of healthcare services, operating over 170 locally managed hospitals and over 100 freestanding surgery centers in 20 states and the United Kingdom. With its founding in 1968, HCA created a new model for hospital care in the United States, using combined resources to strengthen hospitals, deliver patient-focused care and improve the practice of medicine. HCA is a learning healthcare system that uses more than 27 million annual patient encounters to advance science, improve patient care and save lives. HCA has been named one of the world's most ethical companies for eight years in a row. At HCA, we are driven by a single goal: the care and improvement of human life.

JOB SUMMARY


This position is one of the leadership roles in the HCI Claims Department and in the larger Risk & Insurance Department. The Director of Claims is responsible for the overall management of a segment of the Company's professional and general liability claims directly or indirectly. This position will perform file audits of professional claims staff and outside legal counsel each quarter to ensure compliance to department standards and performance against established metrics. This individual has solid experience managing healthcare liability claims, is familiar with hospital operations and has demonstrated management and leadership ability.

GENERAL RESPONSIBILITIES

This position will:

  • Manage a segment of the Company's liability claims to achieve fair and efficient resolution of all matters.
  • Handle high severity cases and perform file audits of professional claims staff and outside legal counsel.
  • Responsibly utilize case reserving and settlement authority within established levels individually and for his/her team and ensure appropriate documentation of the same.
  • Assure accountability among the department for approval of claims expenses and litigation fees.
  • Assure accountability among the department for appropriate documentation within and maintenance of the electronic claims system.
  • Hire and supervise directly, and via the team, outside defense counsel and claim investigators within established guidelines.
  • Effectively participate and counsel team members as appropriate, in settlement negotiations, mediations, arbitrations and trials as required for optimal outcomes.
  • Identify appropriate cases and prepare those for presentation to the AVP, VP and Claims Committee for settlement authority and to excess and reinsurers as needed.
  • Enforce the department and company strategy and philosophy for effective claims management.
  • Ensure a regular diary process is maintained within the team.
  • Utilize monthly loss runs and/or auditing of claims assigned to team members to maintain performance accountability against established metrics.
  • Maintain current knowledge of laws and rules affecting liability claims management decisions; educate and train staff.
  • Develop and maintain effective, efficient and respectful working relationships with local Risk Managers, Patient Safety Directors, CEOs and Division leaders.
  • Build and maintain strategic alliances and collaborative partnerships with the HCI Risk Management team, HCA Law Department, Clinical and Physician's Services Group and other corporate departments that will mutually benefit the Claims Department and the organization.
  • Serve as chairperson and/or participate in committees or task forces as assigned.
  • Integrate and counsel team members on newly developed projects affecting claims and overall company operations (e.g. DCCP, PSO).
  • Maintain current licensure needed to perform duties as required in territory assigned.
  • Perform other duties as assigned by the AVP of Claims
*Caseload may vary based on overall volume of department and territories managed.
Qualifications:
EDUCATION
College Graduate Required Undergrad
Certification in risk management or insurance is a plus, e.g. CPHRM, ARM,
CPCU, etc.

Adjuster's license in states in which HCI operates, especially Florida, is a plus.

EXPERIENCE

6-8 years of claims management experience, preferably in healthcare and preferably in a multi-state environment; knowledge of hospital and healthcare operations.


SPECIAL QUALIFICATIONS


  • Must be eligible to apply for and obtain adjusters license(s) in assigned jurisdictions.
  • Proficient computer skills with word processing and database competency.
  • Effective oral and written communication skills.
  • Critical thinking, analytical and problem solving skills.
  • < 10% travel to meet with business associates, attend claims settlement meetings, seminars, mediations, trials and participate in committees, task forces, etc.


#LI-PT1
INDKD
#CB

A little about us:
HCA is the nation’s leading private provider of healthcare services. Comprised of locally managed facilities which include 230,000 employees at over 160 hospitals, over 120 surgery centers and 100 urgent care facilities in 20 states and the United Kingdom

Know someone who would be interested in this job? Share it with your network.