Yale New Haven Health System

CLAIMS ADMINISTRATOR

US-CT-New Haven
Job ID
62038
Department
LEGAL
Category
LEGAL/COMPLIANCE
Position Type
Full Time Benefits Eligible
Scheduled Hours
40
Work Schedule
DAYS
Work Days
MON - FRI
Work Hours
8:30AM-5:00PM
Work Shift
N/A
Requisition ID
2017-15522

Overview

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values—integrity, patient-centered, respect, accountability, and compassion—must guide what we do, as individuals and professionals, every day.

Responsible for managing General Liability (GL) claims; claim investigation duties of other types of litigation including Professional Liability (PL) and Employment Liability (EPL) claims; monitoring compliance with certain litigation procedures and regulatory reporting requirements related to malpractice payments; administration of the YNHHS legal hold process; support for responding to subpoenas; insurance administration and risk mitigation projects as assigned.

EEO/AA/Disability/Veteran

Responsibilities

  • 1. Professional liability and litigation program functions as assigned:
    • 1.1 Reconcile monthly financial reserve reports.
  • 2. Claims investigation and adjusting duties as assigned:
    • 2.1 Identify and collect relevant personnel, medical, hopsital, and other records necessary to investigate asserted claims and forward them to counsel.
  • 3. Risk mitigation functions as the bridge between Risk Management and Litigation Services including, but not limited to, the following:
    • 3.1 Risk mitigation functions as assigned through timely reporting of applicable events to MCIC; liaison between Risk Management and the disclosure project coordinator; tracking billing waivers; escalating risk potential across YNHHS as identified in claims; and escalating claims/litigation lessons learned or feedback from internal claims committee into risk management plan across YNHHS.
  • 4. Department projects and functions as assigned

Qualifications

EDUCATION

 

Undergraduate degree or High School Diploma, plus formal paralegal and/or claims investigation/adjusting training and/or experience.

 

EXPERIENCE

 

No less than five (5) years working as a claims investigator, claims adjuster or litigation paralegal. Experience in complex litigation is required, medical malpractice and/or general liability litigation experience is preferred. General knowledge of legal practice and procedures and various court systems is necessary. Experience in a healthcare setting with clinical experience is preferred.

 

LICENSURE

 

CT claims adjusters' license and/ or nursing degree is preferred.

 

SPECIAL SKILLS

 

Must have excellent communication skills, both verbal and written. Must demonstrate excellent organizational and problem solving skills. Must possess the ability to interact with all types and levels of personnel, and in stressful situations. Must be able to assist staff with triage and setting of priorities to ensure the smooth operation of the office and exceptional customer service are maintained. Must be able to coordinate several activities at once, quickly analyze and resolve specific problems, and cope with deadlines. Microsoft Office (Outlook, Word, Excel, PowerPoint), Adobe. Ability to learn LRSD document and claims management system.

 

*CB*

 

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