Director-Risk Management & Claims

Description

Purpose of Position and Scope of Responsibility:

Provides leadership oversight for Baptist Memorial Health Care Corporations system-wide claims program including professional liability and general liability matters working in close coordination with the Senior Associate General Counsel Claims Oversight and General Health Law or designee. Responsibilities include but are not limited to providing operational oversight for claims administration for assigned areas of responsibilities across the Baptist system including claim intake investigation documentation reporting reserve review litigation support settlement coordination vendor performance and related activities. Works in partnership with the Legal Services team Risk Management Safety Finance entity leadership clinical and operational leaders third-party administrators insurers brokers and outside counsel to support consistent cost-effective and defensible claim management. Serves as a system-level liaison and promotes a culture of respect in alignment with Baptists Mission Vision Values and CARES Principles.

Essential Functions:

1. Manages the daily operations of the claims function for professional liability and general liability claims across designated Baptist markets to include hospital entities affiliates employed provider settings ambulatory locations and other applicable sites of care or business operations.

2. Coordinates timely claim intake assignment documentation investigation and follow-up to support accurate claim evaluation regulatory compliance and appropriate resolution.

3. Partners with legal counsel risk management operational leaders clinical leaders human resources employee health and safety personnel to gather information evaluate exposure and support effective claim strategy.

4. Serves as an operational contact for third-party administrators insurers brokers outside counsel adjusters and other vendors involved in claims administration and litigation management for areas of responsibility.

5. Monitors claim activity reserves expenses litigation status settlement recommendations recovery opportunities and closure plans to support effective financial stewardship and risk mitigation.

6. Maintains accurate claim files databases dashboards correspondence and reports to support timely communication audit readiness insurance program administration and leadership decision-making.

7. Uses claims analytics and trend data to evaluate claim frequency severity cost status and emerging patterns; identifies actionable insights communicates key findings to appropriate stakeholders and supports data-informed recommendations for operational improvement and risk reduction in conjunction with Risk Management.

8. Assists with insurance renewals actuarial reviews reserve analyses self-insured retention monitoring captive or excess coverage reporting and other insurance program activities as requested.

9. Promotes consistent claims processes across the health care system and supports the development review and implementation of policies procedures workflows templates and training materials related to claims management.

10. Ensures confidentiality and appropriate handling of privileged protected personnel medical and sensitive claim information in accordance with applicable laws policies and organizational expectations.

11. May supervise or provide direction to claims coordinators analysts administrative staff or other team members including workflow assignment coaching performance feedback and process standardization.

12. Performs other duties as assigned or directed.

Qualifications and Experience:

• A Bachelors or Associates degree in business health care administration risk management human resources insurance legal studies or a related field is required.

• Minimum of five years of progressively responsible experiencewith a bachelors degree or eight years of progressively responsible experience with an associates degreein claims management risk management insurance litigation support health care operations or a related field managing professional liability or general liability claims in a health care organization insurance TPA legal self-insured or complex multi-site environment preferred.

• Supervisory team lead or project management experience preferred.

• Working knowledge of professional liability general liability claim investigation litigation management insurance administration reserves settlements and claim closure processes.

• Strong analytical organizational problem-solving and follow-through skills with the ability to manage competing priorities and deadlines.

• Demonstrated proficiency using claims management systems spreadsheets dashboards or similar reporting tools to maintain data integrity monitor key metrics interpret trends and present concise actionable information to support leadership decision-making.

• Knowledge of health care operations patient safety employee safety risk mitigation incident reporting and regulatory considerations affecting claims management.

• Required travel to Baptist entities meetings mediations claim reviews or other business locations as needed.

• Excellent written verbal and interpersonal communication skills including the ability to interact professionally with leaders physicians clinicians team members vendors attorneys insurers and external agencies.

Required Experience:

Director