Senior Claims Litigation Management Specialist

Overview

This position supports the Litigation and Claims Management function of the organization’s self-insurance program.

Work setting: Remote (Arizona residents preferred)

Schedule: Monday–Friday daytime schedule; no after-hours or weekend call

Primary City/State: Phoenix, Arizona
Department: Litigation & Claims Mgmt
Job Category: Risk, Quality and Safety

Responsibilities

• Collect, review, analyze, and summarize documentation and evidence, including medical records, billing statements, policies and procedures, staff schedules, hospital census sheets, information related to equipment issues, and lien information pertaining to claims, pre-litigation, and litigated matters for both civil and criminal claims and/or lawsuits.
• Respond to subpoenas and requests for records related to civil or criminal matters.
• Coordinate witnesses and resources as appropriate for non-suit depositions.
• Assist with scheduling and attending site visits when requested, including when outside counsel or consultants are viewing medical records, equipment, or the facility.
• Identify applicable insurance policies and determine employment and/or contractual status of relevant parties and/or entities.
• Identify relevant physician-related and non-physician related contracts.
• Provide information to Risk Management regarding whether specific parties and/or entities have 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 the 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 issues relating to document and discovery management.
• Provide consultation and leadership related to electronic discovery (“e-discovery”) efforts, including coordination with IT and other departments to collect data and capture Electronically Stored Information (ESI).
• Maintain familiarity with documents and issues involving claims, pre-litigation, and litigation matters to support collection, completion, and distribution of non-litigation and litigation discovery documents, applicable billing statements, and medical records.
• Organize and track submitted information and recommend additional collection to facilitate drafting of 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).
• Save and maintain documents in RMIS on claims, pre-litigation, and litigation matters to ensure the case file is current and well maintained.
• Monitor RMIS data to meet deadlines for Section 111 of the Medicare, Medicaid, SCHIP Extension Act (MMSEA) reporting requirements.
• Monitor compliance with Medicare Secondary Payer (MSP) Act requirements, including recording and monitoring pertinent CMS information in RMIS to ensure regulatory compliance and job-related reporting.
• Maintain a litigation calendar, including subpoena due dates; deposition dates; and appearance dates, as required.
• Maintain a library of 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, such as 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.
• Interact with senior management, physicians, executive leadership, internal 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 as normally 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; summarize information in written form.
• Ability to prioritize multiple projects, coordinate large volumes of data, 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.

Compensation & Benefits

Not specified in the provided description.

Location

Remote (Arizona residents preferred)

Primary City/State: Phoenix, Arizona

Equal Opportunity

The organization supports a drug-free work environment.