Senior Claims Litigation Management Specialist

Overview

This role supports the Litigation and Claims Management function of the organization’s self-insurance program. Responsibilities include compiling, reviewing, analyzing, and summarizing documentation and evidence needed to investigate claims not in litigation and to support litigated matters.

The position is daytime with a Monday–Friday schedule and requires no after-hours or weekend call. Work is remote; Arizona residents are preferred.

Responsibilities

• Collect, review, analyze, and summarize documentation and evidence for claims, pre-litigation, and litigated matters, including medical records, billing statements, policies and procedures, staff schedules, hospital census sheets, equipment-related information, and lien information for civil and criminal matters.
• Respond to subpoenas and records requests related to civil or criminal matters.
• Coordinate witnesses and resources for non-suit depositions.
• Assist with scheduling and attending site visits as requested when outside counsel or consultants review medical records, equipment, or the facility.
• Identify applicable insurance policies and determine employment and/or contractual status of relevant parties and entities.
• Identify relevant physician-related and non-physician-related contracts; provide information to Risk Management personnel on system contracts.
• Secure copies of applicable contracts, employment status of personnel, and curriculum vitae of experts.
• Ensure compliance with company policies and procedures and applicable state and federal rules and regulations, including Business Associate Agreements, Stark, and HIPAA.
• Identify key players and key search terms for Legal Hold purposes.
• Research and review the appropriate court venue docket in state and/or federal court as appropriate.
• Review, analyze, and oversee drafting of responses to preservation requests and legal holds.
• At direction of legal counsel, issue legal holds, monitor compliance, and issue releases upon matter resolution.
• Serve as Risk Management’s liaison to other functions and business units on document and discovery management.
• Provide consultation and leadership on electronic discovery (“e-discovery”) efforts across a range of computer software databases.
• Coordinate with IT and other departments to manage collection processes and capture available, responsive Electronically Stored Information data.
• Maintain familiarity with documents and issues across claims, pre-litigation, and litigation to support collection, completion, and distribution of discovery documents, applicable billing statements, and medical records.
• Organize and track submitted information and recommend collection of additional information to facilitate drafting discovery responses.
• Procure and provide the Risk Management file and other pertinent documentation to Claims Directors and/or outside defense counsel.
• Assist in preparation of discovery responses.
• Obtain and enter data into the Risk Management Information System (RMIS) file.
• Save and maintain documents in RMIS to keep the case file current, organized, and well maintained.
• Monitor data to meet Section 111 of the Medicare, Medicaid, SCHIP Extension Act (MMSEA) reporting requirements related to claimants and others releasing medicals.
• Monitor compliance with Medicare Secondary Payer (MSP) Act requirements, including recording and monitoring CMS information in RMIS.
• Maintain a litigation calendar, including subpoena due dates, deposition dates, and required appearance dates.
• Maintain a library of documents, including archived and active policies and procedures, Medical Staff Bylaws and Rules and Regulations, employee rosters, curriculum vitae of consultants/experts, and Settlement Releases.
• Open claim files into the RMIS database when requested.
• Assist with initial review and assessment of claims, pre-litigation, and litigation matters.
• Request and review pertinent information to support damage claims (including lien information).
• Submit necessary information to consultants/experts for review.
• Collaborate with Claims Directors regarding claim disposition.
• Draft Settlement Release documents, including appropriate MMSEA and MSP language, and National Practitioner Data Bank Reports.
• Work with senior management, physicians, CEO’s, internal leadership and personnel, attorneys, insurance companies, and business personnel regarding medical malpractice non-litigation, litigation, and discovery processes.

Minimum Qualifications

• Strong knowledge of healthcare, litigation, business and/or law, typically obtained through completion of a bachelor’s degree in a related field.
• Strong organizational and analytical abilities, including the ability to interpret internal policies and procedures, medical information, and complex state and federal rules and regulations; must be able to summarize information in written form.
• Ability to prioritize multiple projects, coordinate large volumes of data, and track and meet court-imposed deadlines with limited supervision.
• Ability to maintain strict confidentiality.
• Effective oral and written communication skills.
• Ability to work well as part of a team.

Preferred Qualifications

• Paralegal experience in a defense medical malpractice litigation context.
• Registered nurse with clinical experience.
• In-house claims or risk management experience.
• Additional related education and/or experience.

Compensation & Benefits

• Compensation and benefits are not specified in the provided job description.

Location

• Phoenix, Arizona
• Remote role; Arizona residents preferred.

Additional Information

• Support for a drug-free work environment.
• EEO/Disabled/Veterans