Claims Manager

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This is a Stanford Health Care job.

A Brief Overview
Investigates, manages and resolves reported claims and adverse events defined by Risk Management. Requires coordination with internal stakeholders and staff, as well as oversight and management of panel counsel. Internal investigations include review of medical records, interviews with relevant staff, and analysis of liability and case value. Manages claims information in internal database. Assists Sr. Manager-Claims & Litigation in other claims-related projects as requested.

Locations

Stanford Health Care

What you will do

• Manages litigated claims, evaluates applicable insurance coverages such as professional and general liability, retains outside counsel, attends mediation, monitors litigation costs, and oversees decisions regarding discovery, strategy, and ultimate resolution.

• Investigates pre-suit claims, interviews providers, retains consultants when necessary, prepares case reports, communicates with patients and/or families, and directly negotiates settlements when warranted.

• Prepares claims reports and presents high-exposure cases to leadership and stakeholders, including reinsurance partners.

• Maintains accurate defense and indemnity reserves on assigned claims as facts and circumstances evolve over the life of the claim.

• Inputs all work product and case information into the claims database and manages the database for assigned files to ensure that information is accurate and entered in a timely manner.

• Serves as a resource to other member of the Claims team and Risk Management team members on matters that may have the potential to rise to the level of a claim. Assists in handling general claims or risk management issues as necessary.

Education Qualifications

• Bachelor’s degree required.

• Juris Doctor (JD) degree preferred.

Experience Qualifications

• Five (5) years of progressively responsible and directly-related claim management experience.

Required Knowledge, Skills and Abilities

• 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 and 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.

Licenses and Certifications

• None

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care

• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health

• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination inall ofits policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.