This site uses cookies. To find out more, see our Cookies Policy

Director of Claims - Claims/Insurance Administration - Full Time/Days in Lancaster, CA at Antelope Valley Hospital

Date Posted: 11/15/2018

Job Snapshot

Job Description

Job Objective: The Director of Claims position is a leadership and decision making role, responsible for the development and daily management of the Claims Department operations including the handling of litigated, severe, complex and high-exposure liability claims to a resolution, as well as development and oversight for the Claims Department Team. This job function is performed with the objective of controlling and minimizing the losses in an effort to protect the assets of the entire Antelope Valley Health Care District. Responsibilities are performed with minimal or no supervision.

Essential Duties and Responsibilities:

A. Oversight, management and direction to the Claims Department

  1. Supervise, provide oversight and guidance to the positions of Claims Manager and Insurance/Claims Coordinator and other staff as added to the department
  2. Directs implementation, execution and maintenance of claims policies and claims management systems, claims database and manuals
  3. Implement and execute AVHD policies, claims processes and procedures to AVHD staff, external counsel and insurers.
  4. Prepare all claims for reporting and recommendation to the AVH Board of Directors
  5. Meet and confer with CFO regarding reserves and exposures, develop reports for Accounting regarding reserves on claims handled within the SIR; meet and confer with Human Resources VP regarding reporting of HR claims, the handling and resolution of same
  6. Maintain an accurate account and database of all Claims Department Reports and reporting mechanisms
  7. Develop, implement and maintain claims manuals and procedures for claims handling practices in accordance with best practices
  8. Develop and implement departmental goals and objectives, manage departmental finances, budgeting. Knowledge of Human Resources guidelines, which include evaluations of staff performance. Knowledge in the Kronos pay system and/or time process for staff payroll.
  9. Attend educational training, seminars, conferences as needed or directed

B. Review, investigate, analyze, evaluate and negotiate and resolve high exposure claims

  1. Manage individual claim files, specifically the high exposure or multiple defendant claims, medical malpractice claims and general liability claims.
  2. Review, provide oversight, direction of all potential claim and active claim files handled by Claims Manager
  3. Interface directly with Executive Vice President of Human Resources and the Manager of Employee/Labor Relations on all Employment Claims.
  4. Evaluate claims for the purposes of identifying coverage, liability, damages and litigation/claims management strategy in order to recommend for settlement or resolution

  1. Establish and apply value/quality standards to assess the performance of and supervise third party vendors (claims counsel, claims consultants)
  2. Maintain claims performance standards to insure timely resolution, response and documentation of all claims activities
  3. Establish, maintain and review reserves for each claim throughout the life of the claim file based upon thorough investigation, evaluation and insurance industry standards
  4. Negotiate settlements within authority,
  5. Review and approve payment of all legal and claims related fees, settlements and subrogation activity
  6. Responsible for reporting of claims to the appropriate licensing agencies and/or Medical or Nursing Boards
  7. Develop, analyze and make recommendations for overall Claims Department program based upon claims trends. Develop, implement and monitor policies, procedures, practices and standards for the handling of claims, including in-service and training to staff
  8. Maintain communication with all claimants, internal clients, attorneys, insurance carriers, coordinate the selection of experts with defense counsel, manage litigation and allocated loss adjustment expenses (ALAE)
  9. Attend all trials, mediations, settlement conferences, depositions

C. Collaborate and strategic planning with other departments

  1. Collaborate with the Risk/Quality Department to identify opportunities for improvement as related to claims, facilitate the development and implementation of best practices aimed at reducing AVH claims costs
  2. Provide claims administration/management support to other areas of AVH, assist employees and staff with insurance, legal and claims questions and inquiries
  3. Collaborate with the Education Department to provide claims/legal education to AVH staff, which can include mock trials, deposition training, etc.
  4. Serve on committees, task force groups, quality teams as appointed by the CEO

Non-Essential Duties:

  • Scheduling meetings with defense counsel
  • Process subpoenas for employees related to issues within the confines of their job
  • Opening mail
  • Processing insurance certificates
  • Accepting service of summons and complaints
  • Requesting medical and billing records.
  • Assist with special projects/assignments as needed or directed

Knowledge, Skills and Abilities:

Knowledge

  • Comprehensive knowledge of malpractice, general liability and employment claims management.
  • Extensive knowledge of legal and insurance industry terminology, principles and practices.
  • Thorough knowledge of litigation law
  • Thorough knowledge of hospital professional liability, general liability and employment policy language.
  • Knowledge of regulations and general claims handling, specific to current state and federal guidelines and statutes as well as other compliance issues that affects claims management.

Skills

Demonstrated skills in coverage, liability and damage analysis

Extensive skills in litigation management, which include analytical and problem solving.

Effective organizational skills

Strong oral and written communication skills

Strong leadership skills

Looking for an opportunity to work in healthcare the way you always dreamed you could? At Antelope Valley Hospital, our employees are at the heart of what we do best – delivering high quality, patient-centered healthcare.

Antelope Valley Hospital, a 420 bed acute care facility, located just 60 miles north of Los Angeles, the Antelope Valley is one of Southern California’s fastest growing communities. We are a Level II Trauma Center and Joint Commission Primary Stroke Center Accredited. Serving the community for over 50 years, our non-profit hospital has grown to be the preeminent healthcare facility for our district’s nearly 1.2 million residents. 

An Equal Opportunity Employer.

*CB

#LI-JC1

CHECK OUT OUR SIMILAR JOBS

  1. Claims Examiner Jobs
  2. Claims Manager Jobs