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Director, Claims Management in Knoxville, Tennessee, US at TeamHealth

Date Posted: 3/13/2019

Job Snapshot

Job Description

This job is located in Knoxville, TN

JOB DESCRIPTION OVERVIEW:

The Director is responsible for overseeing the Professional Liability Insurance (PLI) Program for TeamHealth (TH); providing technical expertise to Director of Claims and Claims Managers, interacting with Accounting, communicating with Group Leaders on claims developments and statistics, assisting in evaluation and integration of acquisitions, and communicating with senior leadership on PLI trends.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Acts as a PLI subject matter expert to the Claims Department
  • Monitors Claims Managers’ activity and coding in STARS
  • Oversees and authorizes claims reserves and settlement requests
  • Interacts with various insurance carriers and TPAs to address claim or coverage issues
  • Establishes and maintains list of defense attorney panel and approves hourly rates
  • Meets with panel firms and/or hosts meetings with attorneys to review claims or promote TH initiatives
  • Assists with settlement of large exposure claims
  • Verifies daily transactions and confirms compliance with settlement and reserving guidelines
  • Oversees updating carrier loss runs into STARS
  • Maintains the claims financial data for reporting to actuaries on all PLI programs
  • Provides operation groups with monthly claims activity data
  • Assists Operation Groups with claims related issues, risk management activities and insurance matters
  • Acts as administrator of the TH claims database, overseeing and keeping it updated on new contracts, claims, insurance policies and users
  • Reports to VP Claims & Risk Management and senior leadership on monthly and quarterly claims activity
  • Leads the PLI claims analysis of M&A activity / targets
  • Coordinates and assists with integration of new acquisitions and contracts
  • Updates management and senior leadership on PLI claims with high exposures
  • Responds to all inquiries from auditors.
  • Maintains and reports on upcoming trials

Job Requirements

QUALIFICATIONS / EXPERIENCE:

  • BS/BA degree in Business, Healthcare, Risk Management or equivalent insurance work experience
  • 12 years of medical professional liability claims experience with at least five years at a supervisory level
  • Demonstrated leadership and management skills
  • Advanced negotiation skills
  • Advanced knowledge of insurance coverage, concepts and claim resolution process
  • Intermediate proficiency with personal computers and Microsoft Office programs
  • Excellent written and verbal communication skills
  • Excellent organizational and interpersonal skills

SUPERVISORY RESPONSIBILITIES:

  • Supervises Claim Managers, Litigation Support and Claims Administrative Coordinators

PHYSICAL / ENVIRONMENTAL DEMANDS:

  • Job performed in a well-lighted, modern office setting
  • Occasional lifting/carrying (15 pounds or less)
  • Moderate travel
  • Prolonged sitting
  • Moderate stress with ability to work in a dynamic environment
  • Prolonged work on computer/PC

This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, fax) and/or the ability to perform repetitive motions and/or meet production standards to comply with the essential functions. Also, may require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week.

DISCLAIMER:

The information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.