Medical Malpractice And Claims Manager

George Washington University Washington , DC 20319

Posted 1 week ago

Job Description:Summary:

The Office of Risk Management provides the expertise necessary to maintain a safe and healthy campus environment where bodily injury and property damage risk are prevented or controlled and the potential liability from loss is adequately financed. Their work includes identification and analysis of key risk exposures, recommendation of insurance coverage, and managing incident reporting.

This position performs the following duties:

Manage and administer Medical Malpractice claims and related litigation, including reporting and tracking claims and lawsuits, coordinating with insurance adjusters, working with and overseeing the work of outside legal counsel, and preparing case summaries and reports related to litigation status and trend analysis.

1.Reviews new claims to determine the validity, ascertaining proper filing, identifying the need for further investigations, and following claims through closing or settlement.

2.Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim.

3.Conducts full investigation including interviews of providers, patients, and other individuals.

4.Provides comprehensive report of investigation of assigned incidents, claims, and legal actions.

5.Collects and analyzes all associated damages for completeness and relevance to claimed injuries.

6.In consultation with outside counsel, assessing the MFA's financial exposure and establishing adequate financial reserves for each claim being managed; reviewing the adequacy of financial reserve amounts for each claim and making recommendations as to appropriate adjustments, in light of changed circumstances and developments with respect to the claim;

7.Retains appropriate experts to review standards of care and damages.

8.Communicates & documents claim activities, developments, and plans of action into risk management information system in a timely manner.

9.Prepares and coordinates responses to litigation discovery;

  1. Ensures claim files are properly documented. Responds to audit and excess insurer requests.

  2. Recommends disposition settlement strategies.

  3. Negotiates claim settlement up to designated authority level.

  4. Coordinates legal defense with assigned attorney and ensures compliance with policies and guidelines.

  5. Uses appropriate cost containment measures to control allocated expenses.

  6. Attends and represents MFA in depositions, mediations, and trial monitoring as appropriate.

  7. Participate in producing monthly loss runs, loss data, and risk management dashboards as necessary.

  8. Participate in editing and updating the claims management policies and procedures.

  9. Communicate promptly and professionally when answering questions and gathering claims information.

  10. Conduct detailed legal and expert invoice reviews to implement sound litigation management and expense control.

  11. Performs other related duties as assigned. The omission of specific duties does not preclude the supervisor from assigning duties that are logically related to the position.

Minimum Qualifications:

Qualified candidates will hold a Bachelor's degree in an appropriate area of specialization plus 5 years of relevant professional experience, or, a Master's degree or higher in a relevant area of study plus 3 years of relevant professional experience. Degree must be conferred by the start date of the position. Degree requirements may be substituted with an equivalent combination of education, training and experience.

Additional Required Licenses/Certifications/Posting Specific Minimum Qualifications:
  • Adjuster licenses as required by state

Preferred Qualifications:

  • Experience directly applicable to professional and general liability claims examination.

  • Facility in verbal and written communication is necessary.

  • Professional certification as applicable to line of business preferred

Knowledge in the following areas:

  • Principles and practices of insurance claims examination.

  • In-depth knowledge of appropriate medical malpractice insurance principles and laws.

  • Professional liability claims cycle, including litigation/civil procedure, and knowledge of insurance coverage and policy provisions.

  • Collection and interpretation of data

  • Medical terminology and treatment procedures.

  • Claims Management Systems or database system

  • Enterprise Financial Systems

  • Microsoft Office programs, including Excel and other spreadsheets

Ability to do the following:

  • Conduct investigative interviews using excellent interviewing techniques

  • Interpret and apply laws, rules and regulations.

  • Obtain and utilize sensitive information discretely and objectively.

  • Maintain records, prepare reports and conduct correspondence related to the work.

  • Negotiate to achieve financially effective and efficient outcomes

  • Communicate effectively with others.

  • Maintain favorable public relations.

  • Analyze data, and prepare reports

Typical Hiring Range $73330 - $100789 How is pay for new employees determined at GW?

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Medical Malpractice And Claims Manager

George Washington University