Claims Services Consultant
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Job Location:
Roanoke, VA - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
Employment Status:
Full timeShift:
Day (United States of America)Facility:
213 S Jefferson St - RoanokeRequisition Number:
R156931 Claims Services Consultant (Open)How Youll Help Transform Healthcare:
Assists the Director of Claims at Carilion Clinic with the litigation management process for professional and general liability claims. Collaborates with Claims Specialist on the attorney assist process for Carilion. Produces the loss-run and claims management letters on behalf of BRIC insured providers. Assists with BRIC audit process to ensure compliance with regulatory and governmental requirements.
The Claims Services Consultant functions as a resource to claims specialists within the department while managing 50-60% of open claims independently as directed by Director of Claims Management. Consults with and gathers information for outside council providers employees and others involved in malpractice filings or insurance investigations or claims history.
Communicate receipt of malpractice lawsuit filing or service notice of potential compensatory event via notification from event reporting system risk managers department heads or physicians or notification from attorney of representation of plaintiff.
Communicate with outside attorneys who are providing legal defense to Carilion and its employees
Conduct an investigation at the direction of defense attorneys and report findings back to defense Counsel and Director of Claims management.
Collect pertinent documents information and records for litigation as directed by defense counsel.
Coordinate meetings with defense counsel and Carilion providers and employees
Coordinate and attend meetings to prepare Carilion employees and providers for depositions.
Attend depositions and legal hearings.
Communicate with the Director of Claims Management pertinent case information and litigation milestones
Oversees the attorney assist process to ensure compliance with HIPPA and legal requirements. Ensures that appropriate documentation is executed prior to engaging counsel.
Assists Dir. of Claims in responding to audit requests to ensure regulatory compliance.
Performs trend analysis on claims data as directed by the Dir. of claims management. Reports this data out at various committees and escalates patterns and concerns to the Dir of Claims management.
Oversees and Manages requests regarding insurance verification and claims history information for appointment and reappointment process for:
All current or previously employed physicians
All current or previously employed residents
All current or previously employed mid-level providers
What We Require:
Education: Registered Nurse (BSN) or bachelors degree in health science or Paralegal.
Experience: Minimum three to five years experience required in field. Experience in medical malpractice healthcare or the legal field preferred.
Licensurecertification and/or registration: Advanced education in the field of Risk management or claims management strongly prefered.
Other Minimum Qualifications: Excellent written and verbal communication skills with appropriate use of grammar spelling and/or punctuation. Knowledge of office procedures and equipment. Must have strong organizational skills and be self-motivated. Must be proficient with Microsoft Office Suite including Word Excel PowerPoint Risk Master and Epic. Must be able to deal with patients attorneys and employees at all levels in a diplomatic manner.
Recruiter:
Dave NivenRecruiter Email:
For more information contact the HR Service Center at 1-.
Carilion Clinic is an Equal Opportunity Employer: We provide equal employment opportunities to all employees and applicants without regard to race color religion sex national origin age (40 or older) disability genetic information or veterans status. Carilion is a Drug-Free Workplace. For more information or for individuals with disabilities needing special assistance with our online application process contact Carilion HR Service Center at 8:00 a.m. to 4:30 p.m. Monday through Friday.
Required Experience:
Contract
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