Manager, Claims & Insurance

Job Details

Job Description

Essential Functions

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Assist in the management and supervision of the claims department, including hiring, training, and evaluating staff.
• Develop and implement claims processing policies and procedures to ensure compliance with regulatory requirements and claims management processes. Including implementing best practices and continuous improvement initiatives to enhance claims management efficiency and effectiveness.
• Oversee the investigation, evaluation, and resolution of medical malpractice and general liability claims through the in-house claims team, including the supervision and mentoring of claims adjusters, providing guidance and training as needed.
• Support oversight of claims management process by monitoring workflows, identifying opportunities for improvement, and developing innovative solutions for improvement.
• Work closely with legal counsel to develop defense strategies and manage litigation processes and ensure compliance with applicable Litigation Guidelines.
• Oversee day-to-day operations and use of the program Claims Management Information System to ensure data security, accuracy, integrity and compliance with program requirements for collection and use of claim data.
• Lead implementation of Claims Management Information System upgrades, enhancements, and process changes, as requested.
• Develop and oversee engagement process for strengthening communication and workflows with the enterprise Clinical Risk Management function, including the implementation of an early claim resolution process.
• Serve as liaison between the claims and risk management functions to enhance overall quality and patient safety and improve the risk profile of the enterprise, as requested.
• Design and implement educational programming for clinical and operational staff designed to improve quality and safety and reduce risk and losses.
• Provide guidance related to insurance coverage, policy language, and reporting requirements.
• Travel to conferences, mediations, and trials as necessary.
• Other activities, duties, and responsibilities as assigned.

Competencies (Knowledge, Skills, and Abilities Required):

• In-depth knowledge of appropriate medical malpractice insurance principles and laws, excellent interpersonal skills, ability to work in a team environment, Analytical and interpretive skills, strong organizational skills, excellent negotiation skills.
• Proficient computer skills with claims information management systems (CMIS), word processing and database competency.
• Diplomacy, sincerity, and a passion for vigilantly staying abreast of current industry trends and best practices.

Minimum Education and Experience Requirements:

Education:

• Bachelor's Degree, Masters Preferred

AND

Experience:

• 10+ years of related experience in professional and general liability claims management in healthcare and preferably in a multi-state environment; knowledge of hospital and healthcare operations.
• 5 years' experience in a management position.
• Possess critical thinking, analytical, and problem-solving skills.

Certifications, Registration or License Requirements:

• Adjuster Licenses as required by the state.
• Certification in risk management or insurance, i.e. CPHRM, ARM, CPCU etc. preferred.

Additional Information -Preferred qualifications:

• Experience in both Claims and Risk Management operations with a large academic health system.

Work Shift

Worker Sub Type

Primary Location Address

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.