Liability Claims Specialist (Onsite, Roseville) bei Adventist Health Portland
Adventist Health Portland · Roseville, Vereinigte Staaten Von Amerika · Onsite
- Professional
- Optionales Büro in Roseville
Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.
Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.
Job Summary:
Handles day-to-day oversight of general, professional, and other liability claims in accordance with Adventist Health’s claims program policies and procedures and within an assigned region or scope of responsibility. Maintains up-to-date and accurate claims files, including summaries, action plans, and claims status in the claims data management software, coordinating with market leadership, risk managers, defense counsel, and others. Receives assignments in the form of strategic objectives and is responsible for determining the appropriate tactical approach, resource allocation, scheduling, and goal setting to achieve desired outcomes. Collaborates with a high level of communication and customer service.
Job Requirements:
Education and Work Experience:
- Bachelor’s Degree in risk management, legal studies, nursing, or closely related field or equivalent combination of education/related experience: Required
- Master's Degree: Preferred
- Three years' related experience managing professional and general liability claims within a hospital system, insurance carrier, self-insured environment, law firm setting, or a combination of these: Preferred
Licenses/Certifications:
- Associate in Claims: Preferred
- Chartered Property Casualty Underwriter: Preferred
Essential Functions:
- Manages a portfolio of claims from first notice through resolution. Coordinates litigation activity, including working closely with defense counsel, attending mediations, and contributing to legal strategy and trial preparation. Reviews attorney invoices and monitors counsel for compliance within organization policies and guidelines. Reviews and analyzes medical records, interviewes witnesses, assists with the discovery process and communicates with facility risk manager regarding evaluation and investigation.
- Establishes and adjusts reserves based within organizational authority level. Develops and implements effective settlement strategies, engaging structured settlement professionals when appropriate. Identifies opportunities for subrogation, contribution, and recovery to reduce total claim costs and enhance overall case outcomes. Selects appropriate medical experts for case review.
- Coordinates initial notice to reinsurers and provides timely updates on case status. Maintains accurate and detailed claim files in the claims management system, ensuring documentation of activity, decisions, and communications. Provides direction to support staff.
- Notifies manager of identified trends or patterns in claims that may indicate systemic risk or opportunities for clinical improvement. Prepares claim summaries, reports, and dashboards for management and participates in claims review meetings. Develops and documents for each claim or lawsuit a plan of action for resolution by settlement, trial, or other means.
- Maintains the electronic file including all material communication, correspondence, analysis, expert opinions, interview summaries and all other material documents in accordance with the claims policies and procedures manual. Provides feedback and recommendations, evaluations, litigation trends, department policies and procedures, system-wide claims and litigation processes, and appropriate system risk management issues.
- Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.
