Manager, Claims & Litigation

Summit Health

$111K — $155K *
Legal & Accounting
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's Degree required; paralegal certificate and/or adjuster license preferred.
  • 6+ years of experience in claims, preferably medical malpractice or healthcare risk management.
  • Strong knowledge of medical, legal, and insurance terminology.
  • Excellent communication, organization, and teaching skills required.
  • Ability to perform under time constraints with high accuracy; strong attention to detail.

Responsibilities

  • Provide national claim loss services for providers and employees.
  • Investigate and evaluate complex medical and general liability claims.
  • Document findings and secure necessary records for evaluation.
  • Negotiate settlements and manage third-party claims coordination.
  • Prepare and review responses to written legal discovery requests.
  • Supervise and mentor the Claims Coordinator overseeing complex claims.
  • Monitor legal proceedings and support external counsel as needed.

Benefits

  • Comprehensive medical, dental, and vision coverage.
  • Life and disability insurance options.
  • Flexible spending account (FSA) coverages.
  • 401(k) savings plan to support financial wellness.
Full Job Description
Job Description

Litigation/Claims Management

•    Provide complete national claim loss services for providers and employees of VillageMD and its associated entities. 
•    Investigate and evaluate complex medical professional liability, general liability, and auto liability, keeping the Vice President apprised of all pending matters.
o    Interview providers, staff, witnesses, and other appropriate parties to obtain information used to assess liability exposure.
o    Document files regarding results of investigation. 
o    Secure records for investigation and evaluation of cases.
o    Evaluates cases for appropriate disposition and seeks authority for settlement from Vice President.
o    Determines and implements negotiation strategy and negotiates settlements within authority level
o    Manages third-party commercially insured claims in coordination with the retained TPA.
o    Directs and monitors activities of defense counsel, external insurance coordinators, and agent/brokers.
•    Prepare and review responses to written discovery including interrogatories, notices to produce, and requests for admission.
•    Coordinate responses to subpoena duces tecum and ad testificandum with appropriate departments.
•    Assist in identifying appropriate personnel for production for deposition testimony.
•    Assist in responding to medical record production requests in pending litigation.
•    Monitor trials and attend pre-trial proceedings, mediations, and arbitrations, as necessary.
•    Interact with other departments as necessary to help facilitate and coordinate responses to trends in filed litigation.
•    Identifies potential issues in filed litigation and direct information to the appropriate staff.


Supervisory

•    Directly supervise and mentor Claims Coordinator responsible for managing complex dockets encompassing medical malpractice, general liability, and auto claims.
•    Provide expert direction on day-to-day claims management, offering specific, actionable guidance on evaluating claims and securing appropriate reserve and settlement authorities.
•    Advise coordinator on settlement negotiation tactics and review proposed settlements to ensure outcomes align with the organization's financial objectives.

General Job functions:
•    Claims management monitoring and supporting external counsel handling MPL and GL claims.
•    Maintains litigation files and litigation tracking spreadsheets for all claims handled.
•    Ensures confidentiality of all information at all times

Education, Certification, Computer and Training Requirements: 
•    Bachelor’s Degree required, paralegal certificate and/or adjuster license preferred.
•     6+ years of experience in claims (medical malpractice experience preferred), or health care risk management insurance experience.
•    Knowledge of medical, legal, and insurance terminology is required.
•    Excellent assessment, communication, organization and teaching skills. 
•    Ability to communicate in English, both orally and in writing
•    Ability to perform duties with time limitations with a high degree of accuracy.
•    Strong attention to detail.
•    Standard Office Equipment (Phone, Fax, Copy Machine, Scanner, Email/Voice Mail) and Office Technology in a Windows-based environment.

Physical Job Requirements: 
•    Light lifting
•    Physical mobility, which includes movement from place to place on the job, taking distance and speed into account
•    Physical agility, which includes ability to maneuver body while in place
•    Dexterity of hands and fingers
•    Endurance (e.g. continuous typing, prolonged standing/bending, walking)
•    Memory, taking into consideration the amount and type of information 
•    Complex and time pressured decision making with high degree of accuracy
•    Multi - tasking, organizing & priority setting

Travel: 

•    Travel to other client or other VillageMD locations as needed.
•    Travel to and from offices and satellites as needed.
•    Travel to outside meetings as needed. 

This is an exempt position with the salary range of $111,000 - $155,000 depending on experience.

About Our Commitment
Total Rewards at VillageMD

Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families.  Participation in VillageMD’s benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan.

Similar Jobs

More Jobs at Summit Health

More Legal & Accounting Jobs

Find similar Manager, Claims & Litigation jobs: