Description Summary:The Claims Litigation Manager Per Diem assists in the management of the litigation and claims involving Nuvance Health. The role is focused on the oversight of the litigation process from inception through resolution, including the management of lawsuits and pre-suit claims as assigned, the administration of in-house claims system, and the timely and proper reporting of asserted matters, claims and incidents.Responsibilities:
Manages the in-house occurrence/potential claims reporting program, closely reviewing and monitoring occurrences/claims and trending issues.
2.Assess and analyze claim information and insurance coverage.3.Negotiate and settle claims as assigned.4.Collaborate with internal teams and external stake holders to ensure effective claim resolution.5.Investigate claims and coordinate with internal team members and outside counsel in case/claim management.6.Secure information and items needed for discovery for outside counsel.7.Updates electronic claims systems with file notes on key activities in conjunction with outside counsel reports.8.Develops and manages the in-house loss run program, which contains the following components: occurrence/claimant information, management of reserves, paid expenses, claim status, and outcomes.9.In conjunction with appropriate staff, assist in identification of potential risk through risk assessment, analysis of accidents/incidents and near miss incidents, and periodic safety inspections. Makes recommendations to reduce, prevent or eliminate risks identified.10.Responsible for coordination of interviews, proactively gathering necessary documentation to investigate asserted claims and ensuring secure, protected and confidential file maintenance.11.Reviews draft interrogatory and production responses, organizes meetings and depositions, and oversees billing activities.12.Responsible for the release of records and information in response to subpoenas, court orders, attorney requests, state and federal agency investigations, and other inquiries from outside sources.13.Responsible for notifying physicians, insurers and attorneys when lawsuits are received. Coordinates contact for legal counsel in collecting records, and items needed for discovery.14.Coordinates with Medical Staff Services to develop and maintain risk management profiles on physicians and integrates that information into the credentialing process in compliance with state and federal agencies, Joint Commission and/or other accrediting bodies, and institutional requirements. Assist with preparation of NPDB reports along with ensuring timely reporting.15.Generates various mandated reports/notifications to legal counsel, excess insurance carriers, Medicare, Captive Board, Actuaries, Finance Department and Auditors, and establishes/maintains a tracking system to assure timely notification.16.Fulfills all compliance responsibilities related to the position.17.Maintain and Model Nuvance Health Values.18.Demonstrates regular, reliable, and predictable attendance.
Performs other duties as required.
Other Information
Bachelorïs level degree and/or equivalent experience in claims and litigation management, Risk Management or malpractice litigation field
Minimum Experience: five years
Desired National Risk Management or Claims Management Certification
Claims Certificate
Working Conditions:Manual: Little or no manual skills/motor coord & finger dexterityOccupational: Little or no potential for occupational riskPhysical Effort: Sedentary/light effort. May exert up to 10 lbs. forcePhysical Environment: Generally pleasant working conditionsCompany: Nuvance HealthOrg Unit: 1806Department: Risk ManagementExempt: NoSalary Range: $45.29 - $84.11 HourlyWe are an equal opportunity employerQualified applicants are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other classification protected under applicable Federal, State or Local law.We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation or our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to ensure that you are considered for current or future opportunities.