Claims Adjuster, Legal Affairs (Full-time, Day)

Inspire health. Serve with compassion. Be the difference.

Job Summary
Responsible for day-to-day management of professional and general liability, property, and auto claims. This includes represented and non-represented cases from beginning to final resolution. Maintain professional client relationships during interactions with internal and external parties to successfully resolve claims made against our healthcare providers. Supports the campus/site clinical and administrative leadership team, related Subject Matter Experts (SME), stakeholder groups, and ad hoc teams on claims management and litigation activities.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.
• Plans, controls, and coordinates claim activity and workflow within claims unit/department in order to maintain the highest professional customer service and technical standards, and to ensure work is produced in a timely matter. Responsible for claims management functions to include assignment of defense counsel and monitor case developments. Establishes and maintains litigation budget. Monitors defense and indemnity cost and expenditures. Coordinates and manages litigation.
• Conducts investigations related to new claims/litigation. This includes interviewing providers directly involved or eyewitnesses to an event. Obtains relevant records and documents to defend claims.
• Works in conjunction with defense team to answer discovery. This includes collection of documents for request to produce, interrogatories or request to admit. Schedules meetings to interview team members necessary to answer discovery.
• Maintains claim files, ensuring proper documentation. Initially sets, reviews, and update reserves. Determines evaluations of liability, damages, settlement values, verdict ranges and percent chance to win.
• Participates in key witness meetings, depositions, mediations and trials.
• Performs ongoing analysis of claims and litigation, identifying trends and opportunities to share at claims committee.
• Interacts directly with patients/clients, utilizing professional written and oral communication.
• Coordinates subpoenas and other claim requests.
• Prepares reports on claims status to include making settlement recommendations to leadership.
• Promotes an environment that encourages collaboration and creativity to advance efforts within each operational unit. Maintains and encourages open communication among the various teams within the organization. Works with all levels of leadership and personnel in the formulation and implementation of policies, standardized procedures, and decisions affecting claims management.
• Performs other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Education

• Education - Bachelor's degree in Insurance, Business, Healthcare, Law or related field of study.
• Experience - Five (5) years in medical malpractice/professional liability claims and litigation management.

In Lieu Of

NA

Required Certifications, Registrations, Licenses

Claims Adjuster license preferred

Knowledge, Skills and Abilities

• Knowledge of the legal environment and litigation process
• Knowledge of insurance industry compliance requirements
• Ability to work independently within a defined strategy.
• Ability to work effectively in a matrix organizational structure with many stakeholders.
• Problem solving skills
• Critical thinking / Reasoning skills
• Negotiation skills
• Communication skills

Work Shift
Day (United States of America)

Location
Richland

Facility
7001 Corporate

Department
70019000 Legal Affairs

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.