Manager Claims-Litigations - Risk Management

Job Description

Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:
Reporting to the Associate Vice President of Risk Management, Accreditation and Regulatory Affairs (AVP), the Claims and Litigation Manager is responsible for the investigation of reported claims and the monitoring of incidents that develop into claims against faculty and staff of UNC Health Care System insured by the Liability Insurance Trust Fund (LITF). This position handles internal investigation process of claims, including analysis of medical records, interviews with relevant staff and analysis of value of claim. Assists the AVP in managing external legal counsel hired to represent LITF insureds and manages the lawsuit through resolution. Attends mediations, negotiates and settles claims and lawsuits within the settlement authority provided by the Professional Liability Advisory Committee (PLAC) and/or the LITF Council. Inputs and manages claims information in internal database. Assists the AVP in other projects related to claims as requested. This position also administers medical malpractice claims, assesses liability potential, and provides education designed to reduce claims against faculty and staff of UNC Health Care System covered by the LITF.

Responsibilities:
1. Manages and conducts claims investigations, gathering data from providers and medical staff in a timely manner; researching medical records, protocols, laws, policies and procedures governing the alleged claim. Interviews employees, patient, patient family members, and others who are involved with the incident and claim. Obtains internal and expert opinion reviews, prepares case files in orderly, thorough manner; maintains accurate documentation.
2. Defines issues involved in the case and makes recommendations for settlement strategies. Negotiates and settles medical malpractice claims or otherwise assists in defense of those claims. Gathers information and reviews settlement agreements. Authorizes funding for settlement payments. Manages external legal counsel hired to represent LITF insureds and manages litigation through resolution.
3. Attends conferences with attorneys and staff, mediations, and depositions, and arranges meetings, and communicates policies and procedures to all involved in the claims.
4. Inputs all claims and incident information into claims database. Follows through on patient complaints and legal/risk management matters that have potential to result in claims. Interacts as requested with internal and external stakeholders on scheduling of depositions, conducting depositions, coordination of documents for production and responses to interrogatories, and completion of documentation for claims files.
5. Plans, develops, and presents educational sessions with insured faculty and staff regarding loss prevention and reduction techniques, insurance coverages and exclusions, medical record documentation, legal issues and communication techniques. Provides risk management advice to staff regarding incidents that have occurred or issues that are anticipated. Participates in or leads multidisciplinary RCA meetings (root-cause-analysis).
6. Assists AVP in evaluating the exposure in each claim and other processes related to managing and reducing claims costs. Assists AVP in preparation of claim summaries for PLAC or other risk management or claims reports. Assists AVP in the development of claims and risk management policies and procedures.

Other Information

Other information:
Education Requirements:
● Bachelor's degree in a related field.
Licensure/Certification Requirements:
● No licensure or certification required.
Professional Experience Requirements:
● Five (5) years of experience in risk management, paralegal services, or claims settlement work.
Knowledge/Skills/and Abilities Requirements:

• Ability to analyze and develop solutions to complex problems
• Ability to apply judgment and informed decisions
• Ability to communicate effectively in written and verbal formats including summarizing data, presenting results
• Ability to establish and maintain effective working relationships
• Ability to work effectively both as a team player and leader
• Knowledge of computer systems and software used in functional area
• Knowledge of laws pertaining to professional liability, informed consent, malpractice litigation, and other legal issues
• Knowledge of local, state and federal regulatory requirement related to the functional area
• Knowledge of medical terms, concepts and practice

Job Details

Legal Employer: NC Health 

Entity: Shared Services

Organization Unit: Risk Management 

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Chapel Hill

Exempt From Overtime: Exempt: Yes