Senior Claims Supervisor

Senior Claims Supervisor

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Job Summary and Qualifications

This position is one of the professional staff positions in the HCI Claims Department and in the larger Risk & Insurance Department reporting to a Director of Claims. The Senior Claims Supervisor is responsible for directly managing a caseload of the Company's professional liability claims. This includes in depth analysis, setting reserves, deciding if a claim should be settled or defended and ultimately bringing that claim to a resolution. This individual is responsible for retaining and supervising external and internal claims investigators, defense counsel and regularly interacting with various facility representatives and leaders. Ideally, this individual has litigation experience managing physician practice and hospital claims, is familiar with physician practice and hospital operations (including medical staff issues), state malpractice laws, possesses strong negotiation skills and has demonstrated ability to independently problem solve and proactively manage and resolve claims.

Major Responsibilities:

Quality

• Handle professional liability cases with a designated caseload. This includes strategic thinking towards resolution, as well as collaborating, directing and managing outside counsel and other vendors as appropriate.
• Engage in the department and company strategy and philosophy of proactive, efficient and effective claims management.
• Continuous and appropriate documentation within, and maintenance of, the electronic claims system for designated caseload, including reviewing daily diaries of files to track progress and items needed for updates.
• Identify appropriate cases and prepare those for presentation to the AVP, VP and Claims Committee for settlement authority and to excess and reinsurers as needed.
• Maintain performance against department established metrics.
• Evaluate the efficiency of outside defense counsel based on audits and metrics provided by HCI and firms.

Service

• Manage a segment of the Company's liability claims to achieve fair, efficient, timely exposure assessment, strategy development and ultimate resolution of matters.
• Attend mediations and trials as the Company representative with authority to resolve the claim.
• Maintain current licensure needed to perform duties as required in territory assigned.
• Oversight and administration of special projects as assigned by the Claims Director, HCI President and VP of Claims.
• Have strong experience in coverage evaluation process and coverage issues pertinent to medical professional liability claims.
• Have a strong understanding of risk transfer strategies, to include additional insured standing, contractual indemnity and collateral sources.
• Maintain current knowledge of relevant industry trends, changes in laws and rules affecting liability claims management decisions.
• Perform other duties as assigned.

People

• Work collaboratively with entire HCI Claims team, as well as other HCI departments such as Finance, Business Intelligence and Insurance.
• Assist in evaluation and management of outside defense counsel and claim investigators within established guidelines.
• Develop and maintain effective, efficient and respectful working relationships with the organization's Risk Managers, Patient Safety Directors, C-suite colleagues and Division leaders.
• Conduct division and facility reviews highlighting specific claims and trends in order to support collaboration and quality of care.
• Build and maintain strategic alliances and collaborative partnerships with the HCI Risk Management team, HCA Legal Department, Clinical and Physician's Services Group and other corporate departments that will mutually benefit the Claims Department and the organization.
• Lead and/or participate in committees or task forces, as assigned.

Finance

• Setting appropriate reserves at the opening of a file and continually maintaining that reserve insuring it is aligned with the exposure for the Company throughout the lifetime of the claim.
• Adhere to meaningful metrics to measure individual performance of management of designated caseload.
• Ongoing monitoring of expenses and litigation fees. Reviewing and payment of law firm legal invoices through an electronic platform.
• Responsible for efficient, effective and accurate loss adjustment expenses and indemnity payments.

Education & Experience:

• Bachelor's degree Required
• 5+ years of experience in claims' management, preferably in healthcare and preferably in a multi-state environment; knowledge of hospital and healthcare operations. Required
• Juris Doctorate Preferred
• Defense and trial experience Preferred
• Or equivalent combination of education and/or experience
• Certification in risk management or insurance, i.e. CPHRM, ARM, CPCU, etc. Preferred
• Adjuster's license in states in which HCI operates, especially Florida Preferred
• Must be eligible to apply for and obtain adjuster's license(s) in assigned jurisdictions. Required
• Proficient computer skills with word processing and database competency. Required
• Possess critical thinking, analytical and problem-solving skills. Required
• Service and Quality Excellence: Ability to demonstrate an uncompromising commitment to delivering exceptional care to create an unmatched value proposition for our patients. Required
• Honor our Mission and Values: Ability to build trust and act with authenticity to cultivate a culture of dignity and respect. Required
• Effective Decision Making: Ability to make timely, informed decisions that are in the best interest of our patients, employees, providers, community and HCA. Required
• Attain and Leverage Strategic Relationships: Ability to develop and strengthen collaborative relationships with both internal and external stakeholders to advance the care of our patients and the growth of HCA. Required
• Lead and Develop Others: Ability to lead others to accomplish organizational goals and objectives; provide meaningful coaching and mentoring to increase the capabilities of individuals and teams and drive employee engagement. Required
• Communicate with Impact: Ability to deliver information (both oral and written) in a clear, concise, and compelling manner to effectively engage others and achieve desired results. Required
• Achieve Success through Change: Ability to identify opportunities for improvement and innovation, remove barriers and resistance, and enable desired behaviors. Required
• Drive Execution and Financial Results: Ability to commit to the success and financial wellbeing of HCA by challenging others to excel and hold themselves and others accountable for achieving results.
• The position may require up to 10% travel to meet with business associates, attend claims settlement meetings, seminars, mediations, trials and participate in committees, task forces, etc. Physical demands of travel include extended periods of standing and walking.