Claim Specialist, Litigation

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

Responsible for claim investigation and paralegal duties for medical liability, general liability, premise liability and other claims as assigned; compliance with certain litigation procedures and regulatory reporting requirements related to payments; administration of the legal hold process; support for responding to subpoenas; insurance administration and risk mitigation projects as assigned.

EEO/AA/Disability/Veteran

• Litigation program functions as assigned:
  • Reconcile monthly financial reserve reports, and development of claims related reports as requested.
  • Institutional Claims Committee meeting duties including, but not limited to, identification of reportable matters, preparation of committee materials, and record keeping.
  • Monitor compliance with certain claim handling requirements.
  • Train and monitor litigation support staff to ensure smooth and efficient functioning.
  • Secure data required for submission of NPDB, CMS Section 111 and other claims payment regulatory reports as needed and monitor compliance with regulatory requirements.
  • Respond to insurance and underwriting questions.
  • Assist with response to subpoenas.
  • Legal Hold duties.
  • Claim audit support.
  • Evidence sequestration duties.
• Claims investigation duties as assigned:
  • Complete all claim intake functions including reporting to insurance carriers and maintaining accurate loss runs.
  • Identify and collect relevant records and documents necessary to investigate claims.
  • Witness identification, location and interviews as directed.
  • Schedule case meetings and depositions; participate in preparation meetings as requested.
  • Preparation or assist in preparation of selected interrogatory and production responses; obtain signatures.
  • Develop and document investigation plans in the context of the allegations and litigation management plan within required timeframes.
  • Summarize relevant records in the context of the allegations.
  • Assist in assessing liability, damages and claim value.
  • Assist in developing case management plans.
  • Assist in establishing appropriate case reserves.
  • Coverage identification.
  • Attend scheduled case status meeting with outside counsel as requested.
  • Provide operational expertise to defense strategies and discovery requests.
• Identify and refer risk mitigation opportunities, and function as a bridge between Risk Management and Litigation Services, as applicable, which may include claim analysis and trending.
• Department projects and functions as assigned

EDUCATION

Undergraduate degree or a combination of High School Diploma, AND formal paralegal and/or claims investigation/adjusting training and/or experience required.

EXPERIENCE

Experience in investigating medical liability claims is required, and premise liability claims investigation experience is preferred. General knowledge of legal practice and procedures and various court systems is necessary. Experience in a healthcare setting with clinical experience is preferred.

LICENSURE

Paralegal certification and/or nursing degree is preferred.

SPECIAL SKILLS

Must have excellent communication skills, both verbal and written. Must demonstrate excellent organizational and problem-solving skills. Must possess the ability to interact with all types and levels of personnel, and in stressful situations. Must be able to assist staff with triage and setting of priorities to ensure the smooth operation of the office and exceptional customer service are maintained. Must be able to coordinate several activities at once, quickly analyze and resolve specific problems, and cope with deadlines. Microsoft Office (Outlook, Word, Excel, PowerPoint), Adobe. Ability to learn document and claims management system.

PHYSICAL DEMAND

N/A