Claims Manager

Claims Manager

The Claims Manager is responsible for the overall management of complex, high exposure self-insured Professional Liability, General Liability, Employment and Directors and Officers Liability claims as well as claims and lawsuits insured under the Community Provider Insurance Program: (a) investigates claims, oversees and manages defense counsel, develops defense strategies, and negotiates settlements; (b) attends and monitors depositions, trials, and mediations; (c) assists in the presentation of claims data and reports to the Baystate Claims Committees and Baystate Health's captive (Baystate Health Insurance Company) Board of Directors; (d) partners on the Communication, Apology, and Resolution (CARe) cases for early assessment and resolution of significant unanticipated adverse outcomes of care; (e) interacts with patients and families who have experienced adverse outcomes in a caring and compassionate manner while adhering to organizational objectives and fulfilling duties in a professional manner to achieve the best ethical, safety, and financial outcomes; (f) collaborates with the Risk Managers to report safety concerns identified in claims to the appropriate departments towards prioritizing operational objectives with executives and senior leaders across the system; (g) educates and presents on Risk and Claims Management.

Responsibilities: 

• Conducts a thorough investigation of assigned claims, lawsuits and other matters, including review of complex medical issues, interviews of medical personnel and staff, and review of internal investigation of care issues. Gathers data and information in an efficient and effective manner.
• Documents activities and results of the investigation. Maintains claims files and updates files and databases as claim develops. 
• Evaluates and sets appropriate reserves on claims in compliance with the  Baystate reserving philosophy with oversight of Sr. Director of Claims, Litigation and Insurance. Adjusts reserves to reflect exposure as case develops. Monitors all assigned claims to assure appropriate development of the case, with the goal of achieving resolution when appropriate.   
• Assigns defense counsel from approved panel counsel list or with approval of Sr. Director of Claims, Litigation & Insurance. Works with defense counsel to select appropriate expert witnesses and develop and approve defense strategies. Oversees and manages counsel throughout the litigation with the goal of bringing claim to appropriate resolution.
• Monitors defense counsel’s adherence to Litigation Management Guidelines. Reviews and approves expense and legal invoices to ensure compliance with billing guidelines
• Attends depositions of the parties and monitors trials as a corporate representative. Develops trial strategies with defense counsel and recommends high-low agreements where appropriate.  
• Negotiates settlement of complex medical malpractice claims and other assigned claims. Updates and discusses potential settlement of claims with appropriate management personnel. Utilizes legal tools including mediation to negotiate settlements where appropriate.
• Provides information to reinsurers as requested, including defense and/or settlement strategies, status of litigation, discovery updates, expert reviews, current reserves and financial exposure of assigned claims.
• Conducts investigations of employment and Directors & Officers claims in collaboration with Human Resources. Assigns and monitors defense counsel and assists in the development of defense strategies. Attends MCAD proceedings, depositions, mediations, and trials on behalf of the corporation. Negotiates settlement of employment claims within Baystate's self-insured retention. Works in conjunction with Baystate's commercial EPL/D&O insurance carrier.
• Establishes and maintains processes related to CARe and other system-wide initiatives relative to the Baystate Health Communication & Resolution Program.  Investigates adverse patient outcomes meeting CARe criteria in collaboration with Risk Managers and the CARe Program Manager to determine need for outside expert reviews and establish a plan of action for further evaluation and analysis. When feasible, assures prompt and fair resolution of  claims.
• Participates in claims data collection and reporting to monitor internal severity and frequency trends, to assure adequate reserving practices and to benchmark against the insurance marketplace.
• Mentors other claims handlers, CARe managers and Risk Managers as needed.
• Participates in quarterly regional insurance captive benchmarking meetings.
• Complies with state and federal regulatory reporting requirements such as NPDB, BORM, and MMSEA.

Requirements

• Bachelor's Degree required, Master's Degree preferred in Nursing, Risk Management, Healthcare related field or J.D.
• Seven years of managing professional liability claims, including complex cases.
• Familiarity with state and federal laws pertaining to medical professional liability, general liability and employment practices liability (to include Directors & Officers) claims.

Preferred Work Experience: 

• Prior medical malpractice, employment practices liability, or related claims experience; clinical experience; risk management experience; or legal experience involving medical malpractice litigation.

Skills and Competencies: 

• Excellent written and oral communications skills, analytical thinking, interpersonal skills and ability to make decisions.
• Strong negotiation skills including complex, high value professional liability claims.
• Experience with mediation and arbitration and knowledge of medical terminology.

Schedule & Location

• Full Time,  Monday  - Friday
• Hybrid Opportunity- ability to work a hybrid schedule once fully orientated – Office Location- 280 Chestnut Street

Benefits That Support You

At Baystate Health, you get the best of both worlds: the resources, stability, and career opportunities of a large integrated healthcare system with the supportive culture of a community-focused organization.

Depending on eligibility, benefits may include:

• Competitive Pay & Benefits: Medical, dental, and vision coverage, including local Health New England plans.
• Tuition & Training: Tuition assistance, CEUs, and professional development opportunities.
• Career Growth: Clinical advancement, leadership development, and internal career opportunities.
• Retirement: Retirement savings and employer match.
• Paid Time Off: Generous PTO for eligible employees.
  

Education:

Certifications:

Compensation

Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries may vary by position and will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees.

Minimum - Midpoint - Maximum