Claims Coordinator

Job Summary: Involves oversight of the key compliance related activities affecting the ongoing establishment and maintenance of a culture of compliance. Includes participation in compliance governance, development and implementation of policies and procedures, training and education, communication and reporting, internal monitoring, and auditing. Recommends response, prevention, and disciplinary standards for compliance issues. Ensures alignment with applicable laws, regulations, policies and ethical standards of the organization. Activities include the coordination and triage of complaints of potential allegations of improper behavior, "whistleblowing," and improper governmental activities. Under the supervision of the Investigations Unit Manager, this individual works closely with the Investigations Unit to: Under the supervision of the Investigations Unit Manager, this individual works closely with the Investigations Unit to: Coordinate, triage, and process complaints received by UCSF's Whistleblower Program in accordance with Investigations Unit's Standard Operating Procedures Identify and analyze allegations, make assessments and recommend assignment and/or referral of complaint allegations Maintain a case management system for investigators and other UCSF stakeholders, including ensuring accurate reporting and system administration. Follow-up with investigators and UCSF stakeholders to ensure accurate recordkeeping of assigned matters Assist Manager with data analytics and reporting of complaint data Promote understanding and awareness of the UCSF Whistleblower Program When workload permits, conduct investigations of allegations of improper governmental activities, including but not limited to fraud, retaliation, abusive conduct and other policy violations Respond to requests for information Perform other duties as assigned Department Description: The Office of Ethics and Compliance (OEC) collaborates with the UCSF community and senior leadership to provide oversight and guidance to compliance functions across the enterprise. Our mission is to foster a culture of compliance, which leads to compliant and ethical behavior across all university functions and activities. The OEC organization includes the following units: Investigations; Conflict of Interest; Export Control; Regulatory Support; and Research Integrity. % of time Key Responsibilities 70% Complaint Assessment and Triage - Receives whistleblower complaints and performs policy analyses to assess complaints brought forth through the Whistleblower Program Makes recommendations for triaging complaints to the Locally Designated Official (LDO) with the support of Investigations Unit Manager. Liases with stakeholders in support of complaint triage and coordination. Conducts intake interviews and gathers preliminary evidence from parties and stakeholders to ensure appropriate assignment and/or referral of complaint allegations. Maintains and ensures accurate and appropriate documentation of assessments, triage, case assignments, dispositions, including closed cases that require corrective action by management on EthicsPoint and i-Group databases Trains, advises and assists others in the use and maintenance of the database. Administers the investigations case management system, including data analytics and reporting 10% Investigations Workgroup (i-Group) Facilitation and Reporting - Coordinates, organizes and schedules i-Group meetings. Creates the agenda in coordination with i-Group members for key discussion points. Provides support to the Locally Designated Official. Prepares reports for dissemination to the i-Group and senior leadership 10% Conducts Workplace Investigations - Responds to and investigates simple to moderately complex and highly sensitive UCSF complaints of violations of policies that include, but are not limited to, improper governmental activities and retaliation. Under the supervision of the Investigations Unit Manager: Works to effectively conduct assigned investigations (including but not limited to developing an investigative plan, contacting identified witnesses, documenting the investigative steps and maintaining detailed records). Assists in assessing complaint referrals and provides input in defining the scope of the investigation. Obtains legal opinions when appropriate to inform investigative activities. Prepares comprehensive and factually accurate internal investigative reports in accordance with university standards. Interacts with and provides UCSF stakeholders, management, staff and parties, as appropriate, investigation updates and finding. Refers non-policy violation issues identified during the course of an investigation to appropriate University officials. 5% Process Improvement Activities - Oversees on-going development and improvement of data collection and reporting on cases and makes suggestions on how to improve complaint triage processes. Keeps abreast of best practices of whistleblower programs/hotlines and identifies and recommends process improvements. Participates in committees, task forces or meetings with management and other UCSF stakeholders regarding issues that are novel or with little precedence, requiring expedient and diplomatic action. Liases with investigators and whistleblower program administrators from other locations, including collaboration with the Office of the President and other location colleagues to address complex system-wide issues with significant impact. Keeps abreast of best practices of investigation techniques and utilizes this knowledge during each stage of the investigation process in alignment with University policy with assistance from Manager. 5%Other Duties as Assigned100% (To update total %, enter the amount of time in whole numbers (without the % symbol - e.g., 15, 20) then highlight the total sum (e.g., 1%) at the bottom of the column and press F9. The total sum should add up to 100%.) Required Qualifications: Bachelor's degree in related area and / or equivalent experience / training Minimum three years' experience working in the ethics and compliance profession Minimum 3+ years of related experience Advanced knowledge of ethics and compliance profession, theories and systems of internal control, and professional compliance and investigations standards Broad knowledge of University ethics and compliance policies, procedures and programs, applicable state and federal employment laws Experience issue spotting, analyzing information, identifying issues or concerns in fact patterns Experience applying laws and policy standards in investigation or fact-finding processes Ability to define problems, collect data, ascertain facts, and draw valid conclusions based on evidence Ability to extract, verify, compile and develop recommendations related to ethics and compliance programs, issues, policies and procedures Excellent analytical, legal writing, and/or technical writing skills resulting in soundly-reasoned, accurate, useful reports and/or summaries Ability to present complex information in a clear and concise manner both in writing and verbally for presentation to or review by leadership. Ability to interview and elicit cooperation and confidence of interviewees to obtain relevant information, interpret responses, and determine relevant facts Excellent interpersonal (i.e. verbal and written communications) and problem solving skills and ability to work collaboratively with diverse groups, including all levels of University personnel, including management and faculty, and to facilitate agreement on issues and corrective actions Demonstrated experience in critical decision making and reasoning ability Demonstrated ability to handle extremely difficult, sensitive and/or volatile situations/individuals effectively Strong project management skills including planning, overseeing progress to ensure timely completion, and communicating progress with stakeholders Computer Skills: Proficient in MS Office Suite Preferred Qualifications: Professional certification(s) applicable to job responsibilities, including, but not limited to AWI-CH and/or Certified Fraud Examiner Knowledge/Experience operating or being an administrator of an information database Demonstrated experience with complaint triage, coordination, and assessment. 3+ years of experience with direct responsibility conducting workplace investigations Work experience to include assessing complaint allegations and conducting investigations in the public sector, higher education, and/or health care settings as well as responding to complaints filed with external agencies. Required Qualifications: Bachelor's degree in related area and / or equivalent experience / training Minimum three years' experience working in the ethics and compliance profession Minimum 3+ years of related experience Advanced knowledge of ethics and compliance profession, theories and systems of internal control, and professional compliance and investigations standards Broad knowledge of University ethics and compliance policies, procedures and programs, applicable state and federal employment laws Experience issue spotting, analyzing information, identifying issues or concerns in fact patterns Experience applying laws and policy standards in investigation or fact-finding processes Ability to define problems, collect data, ascertain facts, and draw valid conclusions based on evidence Ability to extract, verify, compile and develop recommendations related to ethics and compliance programs, issues, policies and procedures Excellent analytical, legal writing, and/or technical writing skills resulting in soundly-reasoned, accurate, useful reports and/or summaries Ability to present complex information in a clear and concise manner both in writing and verbally for presentation to or review by leadership. Ability to interview and elicit cooperation and confidence of interviewees to obtain relevant information, interpret responses, and determine relevant facts Excellent interpersonal (i.e. verbal and written communications) and problem solving skills and ability to work collaboratively with diverse groups, including all levels of University personnel, including management and faculty, and to facilitate agreement on issues and corrective actions Demonstrated experience in critical decision making and reasoning ability Demonstrated ability to handle extremely difficult, sensitive and/or volatile situations/individuals effectively Strong project management skills including planning, overseeing progress to ensure timely completion, and communicating progress with stakeholders Computer Skills: Proficient in MS Office Suite Preferred Qualifications: Professional certification(s) applicable to job responsibilities, including, but not limited to AWI-CH and/or Certified Fraud Examiner Knowledge/Experience operating or being an administrator of an information database Demonstrated experience with complaint triage, coordination, and assessment. 3+ years of experience with direct responsibility conducting workplace investigations Work experience to include assessing complaint allegations and conducting investigations in the public sector, higher education, and/or health care settings as well as responding to complaints filed with external agencies.