Senior Claims Attorney Gainesville OR Jacksonville

Classification Title:

Senior Claims Attorney - Gainesville or Jacksonville

Classification Minimum Requirements:

Law degree (L.L.B. or J.D.) and three years of experience in the legal medical or health care fields.

Job Description:

This position can be located in Gainesville or Jacksonville. This position is responsible to the Deputy Administrator.

1. The intake processing and disposition of all incidents report and/or referred to the Self-Insurance Program;
2. The identification investigation analysis and evaluation of the medical legal and fiscal issues related to covered claims potential or asserted against Participants of SIP;
3. The coordination management and resolution including denial settlement or defense of all covered claims with or without Notice of Intent potential or assert against SIP participants including the coordination management and execution of all presuit legal and administrative process required by Florida Statute;
4. The coordination and management of litigation processes in defense of lawsuits filed based on covered claims
5. The identification of risk factors which cause or contribute to claims and suits; and
6. The coordination of effort with the SIPs Loss Prevention staff to mitigate or remove identified risk factors.
7. Intake processing and disposition of all incidents reported and/or referred to the Self-Insurance Program: Pursuant to Rule 6C-10.001 Regulations of the Florida Board of Governors SIP is responsible for establishing incident reporting procedures to be followed by the various units of the Health Science Center and other SIP participants. Consequently it is the responsibility of the incumbent to ensure all reported incidents are reviewed and evaluated for patient care and health care delivery improvement opportunities and for potential claims falling under the purview of the SIP. This includes but is not limited being available on a direct access basis to take incidents reports ensuring that reported incidents are promptly and accurately recorded in the Riskonnect database; performing all interviews records reviews and information analysis necessary to determine the chronology of events and resultant outcomes of an incident; and ensuring that appropriate administration at SIP is timely notified of significant incidents in order that those incidents may be viewed by the Director and when appropriate timely reported to the administration of the affect SIP participant(s). Participants with whom the incumbent will have daily contact include but are not limited to the faculty staff and administration of:

-University of Florida Colleges of Medicine Dentistry Pharmacy Nursing Veterinary Medicine (including VMTH) Health-Related Professions and their affiliated facilities and programs throughout the State of Florida

-Shands Jacksonville Medical Center and its affiliated facilities

-Florida State University College of Medicine and its affiliated facilities and programs throughout the State of Florida

-University of Central Florida College of Medicine and its affiliated facilities and programs throughout the State of Florida

-Florida International University College of Medicine and its affiliated facilities and programs throughout the State of Florida

-Florida Atlantic University College of Medicine and its affiliated facilities and programs throughout the State of Florida

8. Identification investigation analysis and evaluation of the medical legal and fiscal issues related to covered claims potential or asserted against Participants of the SIP: The incumbent is responsible for the identification review investigation and analysis of claims potential or asserted against SIP participants. This includes but is not limited to conducting a full factual investigation of assigned claim files; evaluating claims in terms of negligence causation and compensable damages; presenting initial claims summaries to SIP internal committees; preparing claim summaries and making indemnity and allocated loss expense reserve recommendations pursuant to established protocols; serving as advisor to and investigator for the Self-Insurance Program Counsil and its Claims and Litigation Committee; and providing such assistance as required in fulfilling SIP administrative responsibilities including the presentation of claims summaries and related reports.

9. Coordination management and resolution including denial settlement or defense of all covered claims with or without Notice of Intent potential or asserted against SIP Participants including the coordination management and execution of all presuit legal and administrative process required by Florida Statute: The incumbent is responsible for the management and resolution including denial settlement or defense of all assigned covered claims potential or asserted against entities and individuals protected by the Self-Insurance Program. This includes but is not limited to undertaking a full factual investigation and timely response to assigned claims asserted and potential; preparing timely appropriate responses to presuit information requests and production; tracking the progress of all assigned cases in presuit to ensure that appropriate responses negotiations and settlement offers or alternatively denials and aggressive proactive defense are accomplished for the timely resolution of claims as required by Florida Statute and policy set by SIP Management; initiating the employment and retention of experts; undertaking the preparation of witnesses and participating in unsworn statements and other presuit discovery. This also includes monitoring files to ensure appropriate reserves are in place and allocated loss expense and indemnity payments remain within authorized limits.

10. Coordination and management of litigation processes in defense of lawsuits filed based on covered claims: The incumbent is responsible for identifying reviewing investigating and analyzing claims with legal interest asserted against SIP participants. This includes but is not limited to monitoring and continuing the full factual investigation of asserted claims through litigation; coordinating and ensuring timely response to interrogatories and production; tracking the progress of assigned all cases in litigation to ensure that an aggressive proactive defense and resolution of claims is accomplished within the timeframe set by SIP Management; initiating employment and retention of experts; undertaking the preparation of witnesses including assisting outside legal outside counsel hired by the Program in the preparation of fact and expert witnesses for depositions related to claims in litigation and to assist outside legal counsel during said depositions; and developing defense strategies. The incumbents responsibilities also include assisting in the selection of outside legal counsel and participating at all significant hearings depositions mediations and trials. This also includes monitoring files to ensure appropriate reserves are in place and allocated loss expense and indemnity payments remain within authorized limits.

11. Identification of risk factors which cause or contribute to claims and suits: Incumbent is responsible for coordinating and ensuring that assigned files are reviewed and analyzed for potential loss prevention activities and that assigned files contain appropriate documentation pertaining to loss prevention and risk reduction initiatives associated with the claim. This includes but is not limited to collaborating directly with the SIP Loss Prevention staff to identify potential risk and opportunities for loss reduction recommending activities to mitigate or remove identified risk factors and assisting in follow-up on loss prevention programs; providing advise and assistance on an immediate access basis regarding patient care liabilities and protocols related to loss prevention; conducting in-service education programs seminars and topical presentations for faculty physicians residents nurses or other healthcare providers; developing loss prevention awareness through regular interaction with healthcare providers; and demonstrating the benefits of established loss prevention programs and successful effort resulting from the proactive management of potential risks.

12. Extensive travel is required. This includes but is not limited to meeting with and preparing expert witnesses for deposition and trial; attending depositions throughout the United States and occasionally in foreign countries.

13. Provides investigative and administrative management in support of healthcare providers subjected administrative proceedings related to their license and facilitates the procurement of legal counsel for these providers.

14. Incumbents licensed to practice law in the State of Florida are expected to prepare witnesses employed or formerly employed by covered entities for unsworn statements in presuit discovery and may represent covered entities at unsworn statements and depositions in those situations and circumstances where prior approval has been obtained. Attorney incumbents may also be called upon to perform a variety of legal work including but not limited to the preparation of memos of law the preparation of legal responses the preparation of witnesses before trial and the conduction of legal research.

Expected Salary:

Commensurate with education and experience.

Required Qualifications:

Law degree (L.L.B. or J.D.) and three years of experience in the legal medical or health care fields.

Preferred:

Knowledge of tort law health care systems risk management techniques and medical malpractice claims handling experience is essential as is the ability to perform under great pressure in a multi-tasking environment. Demonstrated competency in medical research and internet research skills is preferred. Must have excellent oral and written communication skills good native intelligence and an ability to interact with individuals of all social and economic backgrounds.

Special Instructions to Applicants:

In order to be considered you must upload your cover letter and resume.

This position is open until filled.

Health Assessment Required: No.

Required Experience:

Senior IC