SummaryReporting to the Chief Legal Officer, the Senior Director, Risk Management builds and leads the Company's risk management function, including accountability for insurance claims management, clinical risk management, and oversight of the company's insurance portfolio and coverage strategy. The Senior Director establishes the processes, technology, governance, and measures required to support progressively higher levels of retained risk. The Senior Director is also expected to be capable with artificial intelligence tools and to assess where and how AI can be deployed to strengthen the risk management program. This is a strategic and hands-on leadership role supporting a national health care organization that includes a medical group employing approximately 350 physicians and 1,250 advanced practice providers across more than thirty states, two multi-state Medicare ACOs, and a multi-state Medicare Advantage ISNP.
The Senior Director leads the Company's claims management strategy from first notice through final resolution, including investigation, liability and damages evaluation, exposure assessment, reserve recommendations, panel counsel oversight, mediation and settlement strategy, and trial posture. The successful candidate will remain personally engaged in significant claims while building the Company's broader risk management capabilities. The Senior Director will also design and implement a robust clinical risk management program that converts claims, complaints, and adverse-event information into trend identification, education, and measurable risk reduction. A core measure of success is demonstrated improvement in total cost of risk, including retained loss outcomes, defense spend, and insurance program economics.
Essential Duties & ResponsibilitiesClaims Management- Serves as the Company's senior claims leader and designs a claims management function capable of supporting progressively higher levels of retained risk.
- Leads the Company's strategy and active participation in complex medical professional liability claims from first notice through final resolution, including fact development, medical-record review, witness identification, and preservation of evidence.
- Evaluates liability, causation, damages, venue and verdict risk, and potential exposure; develops documented strategy and resolution recommendations with the carrier and panel counsel. Supports litigated matters through discovery, witness and deposition preparation, expert selection, and trial preparation.
- Develops and maintains independent per-claim reserve positions that account for the Company's retained exposure separately from carrier reserves, including documented liability, damages, and venue analysis on each significant file. Presents material reserve movements and aggregate retained loss forecasts to the CFO on a defined cadence, and supports accrual and audit positions in coordination with Finance and the CLO.
- Develops settlement recommendations and obtains internal authority; leads the Company's mediation and settlement planning and participates actively with the carrier and panel counsel in negotiations and resolution decisions, subject to policy terms and carrier authority.
- Participates in selection of defense counsel from carrier-approved panels where permitted; works closely with panel counsel; evaluates performance; recommends litigation plans and budgets; and escalates concerns to the carrier and Legal department.
- Designs the operating model for claims administration, including appropriate use of internal personnel, carriers, third-party administrators, consultants, and technology. Establishes claims triage, escalation, file documentation, and authority protocols aligned with carrier requirements and with practices designed with the Legal department to preserve attorney-client privilege and work-product protection.
- Identifies, evaluates, and deploys artificial intelligence and analytics tools to strengthen claims work, including intake and triage, medical-record review and summarization, exposure analysis, loss-trend detection, and review of defense counsel budgets, with appropriate human review and controls for privilege and protected health information.
- Oversees carrier and excess-carrier notice and reporting, loss-run reconciliation, and coverage analysis; escalates disputed coverage positions to the Legal department.
- Administers consent-to-settle requirements and coordinates National Practitioner Data Bank and state licensing-board reporting with the Legal, credentialing, and clinical functions.
- Manages employment and other insured claims in coordination with Human Resources, employment counsel, carriers, and other internal stakeholders.
- Establishes claim review cadence and metrics addressing frequency, severity, loss development, defense spend, cycle time, resolution outcomes, and recurring causes of loss. Establishes and tracks total cost of risk metrics including retained loss ratios, defense spend as a percentage of indemnity, and year-over-year program cost movement, and presents performance against external benchmarks to the CFO and CLO on a quarterly basis.
- Coordinates actuarial loss forecasting and incurred-but-not-reported analyses and partners with Finance on accrual methodology, retained-loss forecasting, collateral, and audit support.
Clinical Risk Management Program Development- Designs, builds, and leads the Company's clinical risk management program including its operating model, staffing, workflows, escalation criteria, and measures, in partnership with clinical, quality, credentialing, operational, legal, and finance leaders.
- Aggregates and analyzes claims, complaint, adverse-event, and near-miss information to identify trends by specialty, care setting, site, region, clinician cohort, allegation, and contributing factor.
- Applies AI and analytics to event, complaint, and claims narratives to surface contributing factors and emerging trends at a scale that manual review cannot achieve, and validates outputs before they inform clinical risk conclusions.
- Defines and reports key measures, including claim frequency and severity, loss development, defense spend, total cost of risk, resolution cycle time, and education completion.
- Translates trends into targeted risk-reduction initiatives and clinician and staff education, including documentation, informed consent, communication, goals-of-care discussions, and transitions of care.
- Develops practical event and near-miss reporting capabilities for clinicians practicing in facilities controlled by third parties, including interfaces or parallel reporting channels.
- Provides risk management consultation regarding adverse events, unanticipated outcomes, disclosure conversations, escalated complaints, and other high-risk clinical situations.
- Supports the Legal department's evaluation and implementation of a patient safety organization strategy and patient safety evaluation system.
- Partners with the Chief Medical Officer and other clinical leaders to establish and mature peer review and clinical risk review governance. Recommends committee charters, referral criteria, decision rights, escalation paths, and documentation standards.
- Supports separate processes for review of individual practitioner performance and for systems and aggregate risk trends, with distinct charters and documentation protocols.
- Serves on the Credentialing Committee and coordinates the flow of claims, event, and loss information among claims, clinical risk, peer review, and credentialing.
Insurance Portfolio and Risk Financing- Provides strategic oversight of the Company's insurance portfolio, including professional and general liability, managed care errors and omissions, property, automobile, employment practices, management and fiduciary liability, cyber, and workers' compensation.
- Oversees the national insurance broker relationship and directs renewal strategy, marketing, submissions, coverage comparison, and negotiation of terms, pricing, limits, and retentions.
- Negotiates and administers the program terms that determine the Company's ability to influence claim outcomes, including claims-handling protocols, panel counsel approval rights, insured consent-to-settle provisions, a dedicated adjuster with defined escalation, scheduled claim reviews, participation in reserve and mediation discussions, and claim-level data access.
- Delegates broker relationship management, insurance administration, and portfolio management to the Senior Manager, Risk Management while retaining accountability for overall strategy and performance.
- Advises the Chief Legal Officer, Chief Financial Officer, and other executive leaders regarding limits, retentions, coverage gaps, program structure, and total cost of risk.
- Develops a multi-year risk financing roadmap that evaluates the economic case for increased self-insurance, TPA engagement, fronted programs, and captive formation, and presents recommendations with financial modeling to the CFO and CLO. Leads evaluation, selection, and ongoing performance management of TPA, including RFP development, fee and authority structure negotiation, claims-handling protocol design, adjuster accountability frameworks, and periodic performance audits against defined metrics. Evaluates proposed increases in the Company's self-insured retention and develops a multi-year recommendation on movement toward a structure in which the Company controls defense and settlement, including a fronted program or a captive. Candidates with experience supporting the feasibility analysis, formation, or operation of a captive insurance company are particularly competitive for this role.
Program Leadership and Other Risk Management Responsibilities- Owns the AI roadmap for the risk management function, including use case identification, tool evaluation and selection, standards for human review and data governance, measurement of results, and coordination with Legal, Compliance, and Information Technology on vendor diligence and data handling.
- Develops a multi-year roadmap for claims management capability, clinical risk management, insurance oversight, staffing, technology, governance, and performance measurement.
- Develops and manages the Risk Management budget, including staffing, insurance premium spend, retained losses, and claims-related outside counsel expense.
- Advises leadership on risk and insurance implications of the Company's own use of artificial intelligence, including in clinical documentation and decision support.
- Develops and maintains a risk register and supporting taxonomy covering insurable, clinical, and operational risk, with named owners and mitigation tracking.
- Selects and implements a risk management information system integrating claims, event, complaint, insurance, and loss data.
- Oversees insurance and claims diligence for acquisitions, joint ventures, and de novo market entry, including loss-run analysis, prior acts and tail coverage, and integration of acquired entities.
- Legal advice, privilege determinations, and legal positions are provided by the Legal department. The Senior Director implements the resulting protocols and escalates legal questions.
QualificationsKNOWLEDGE, SKILLS, AND ABILITIES- Deep expertise in medical professional liability claims management at both the individual-case and portfolio levels, including reserve recommendations, liability and damages evaluation, litigation and settlement strategy, venue and verdict assessment, and effective partnership with carriers and panel counsel.
- Practical fluency with AI tools and sound judgment about where they create value, where they introduce risk, and what level of human review each use requires.
- Ability to establish credibility with physicians and advanced practice providers and influence clinical and operational behavior without direct authority.
- Working knowledge of health care risk frameworks, including peer review and quality protections, HCQIA, PSQIA, National Practitioner Data Bank reporting, and protected investigations.
- Executive presence and ability to translate technical claims, insurance, and clinical risk matters into concise recommendations for senior leadership.
EDUCATION AND CERTIFICATION- Bachelor's degree required. Advanced degree preferred, including Juris Doctor, Master of Health Administration, Master of Business Administration, Master of Science in Nursing, or comparable degree.
- Professional credential preferred, such as CPHRM, AIC, ARM, CPCU, or RPLU.
- Clinical training or active clinical licensure is valued but not required; the Senior Director is expected to recruit and lead clinically trained risk professionals.
- An active license to practice law is not required. Candidates with legal training are welcome, but the role is an operational risk and claims leadership position and does not serve as the Company's legal counsel.
EXPERIENCE- Ten or more years of progressively responsible experience in risk management, including at least seven years of s
