SHS-RISK MANAGEMENT CLAIMS SPEC
Positions Location: Lansing, MI
Job Description
General Purpose of Job:
The Risk Management Claims Specialist works with members of the Risk Management Department, defense counsel and TPA staff by providing support to enhance the effectiveness of the Systems risk and claims management program.
Essential Duties:
This job description is intended to cover the minimum essential duties assigned on a regular basis. Caregivers may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position.
Makes initial contacts with Physicians/Caregivers involved in anticipated litigation, pending claims and lawsuits, and arranges interviews and meetings for the Director and retained defense counsel.
Accepts and processes subpoenas for deposition/testimony of employed Physicians and other Caregivers and responds to questions pertaining to subpoenas and other requests received from non-hospital attorneys.
Originates and drafts correspondence and claims-related documents and resolves issues within the scope of responsibility.
Communicates directly with insurance companies upon receipt of a claim and provides claim intake information.
Communicates directly with defense counsel regarding highly confidential and sensitive information relating to pending claims and lawsuits, including responding to law firm requests for discovery.
Reviews, researches, and assists with answering interrogatories and discovery requests, and provides response to defense counsel.
Maintains files and up-to-date listings of secured medical records, assigned attorney list and claims data.
Works with TPA’s claims software program to create and prepare reports from database information.
Maintains confidential information, and assists in organizing, accessing, and retrieving information pertaining to claims, litigation, occurrence reports and closed files.
Supports the Director and Risk Managers in their investigations of patient occurences and anticipated litigation including but not limited to meeting with the involved Caregivers, reviewing medical records, arranging for expert review of care provided and discussing care with expert reviewers.
Communicates direcrlty with consultants and Caregivers regarding risk management assessments and related action plan progress.
Compiles and assists others with the completion of monthly, quarterly and annual dashboards and reports related to claims and risk occurrences.
Files .
Researches and communicates with patients, visitors, and Caregivers regarding damaged, lost, or stolen property, including coordinating reimbursement when appropriate.
Maintains information on payments made for general liability issues, litigation and claims.
Maintains and updates all policies and procedures related to Sparrow Health System risk management program including policy drafting.
Performs other similiar duties as assigned.
Job Requirements
General Requirements
• None
Work Experience
• Two (2) years or more experience in risk management, health information management, or insurance and claims management.
• Two (2) years or more of work experience in a fast paced office environment.
Education
• Associate's degree in business or a related field
Specialized Knowledge and Skills
• Ability to work in a team environment and independently with minimal supervision.
• Ability to handle multiple projects simultaneously.
• Excellent oral and written communication skills.
• Demonstrated ability to interact efficiently and effectively with others.
• Ability to draft and respond to discovery requests.
• Knowledge of professional and general liability claims processes.
• Strong organizational skills.
• Ability to deliver highest quality work in a high volume, fast paced office environment.
• High level of discretion and confidentiality.
• Typing skills of 55wpm required.
• Advanced computer skills including Word, Excel, PowerPoint.
• Knowledge of medical terminology.
• Ability to exercise discretion and judgment in relaying information, responding to requests, and prioritizing workloads.
• Demonstrates ability to use a keyboard as may be required to perform the essential duties of the job.
• Knowledge of risk management information systems - preferred
• Familiarity with hospitals or the health care industry - preferred
Sparrow Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.
