Job Description
Participates in the management of a Claims Management Program. Prioritizes and monitors claims filed, evaluates insurance coverage, ensures reporting of claims to primary and excess insurance, conducts and/or monitors claims audits; evaluates and monitors reserves; oversees defense counsel.
Job Responsibility
- Monitors a comprehensive, integrated system for managing non-workers’ compensation claims for the organization and its affiliates; assists in managing a caseload of assigned claims.
- Ensures reporting of claims to insurance carriers; conducts insurance coverage analyses.
- Reviews and evaluates insurance carrier coverage responses including reservation or rights and coverage denials; evaluates loss runs to ensure adequate reserving of claims at all layers of primary and excess coverage.
- Oversees third party claims and defense counsel in the management of all aspects of assigned claims including day-to-day management, case reserves, expenses and motion practice; maintains current claim information in the database.
- Ensures appropriate expert reviews; evaluates claims focusing on exposure, severity, reserves, and trial dates.
- Monitors cases on trial and attends trials, when necessary; identifies cases requiring early/pre-trial resolution.
- Collects and reviews claims data to identify trends and opportunities for loss control; collaborates with risk management to recommend loss control initiatives.
- Serves as a liaison between the organization, Third Party Claims Administrator and Insurance Broker in all aspects of claims management; monitors claims impacting on the health system's Insurance Captive Insurance company, Self Insurance Program and/or deductibles, Reviews insurance and related provisions of written agreements.
- Operates under general guidance and work assignments are varied and require interpretation and independent decisions on course of action.
- Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not essential functions.
Job Qualification
- Juris Doctor required.
- 1-3 years of relevant experience, required.
*Additional Salary Detail
The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).
Skills Required
- Juris Doctor
- 1-3 years of relevant experience
What We Do
Northwell Health is New York’s largest private employer and health care provider, with 23 hospitals and nearly 800 outpatient facilities. We care for over two million people annually in the New York metro area and beyond, thanks to philanthropic support from our communities. Our 74,000+ employees – 18,500+ nurses and 14,200+ credentialed physicians, including about 4,500 employed doctors and nearly 3,300 members of Northwell Health Physician Partners – are working to change health care for the better. We’re making breakthroughs in medicine at the Feinstein Institutes for Medical Research. We're training the next generation of medical professionals at the visionary Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies. For information on our more than 100 medical specialties, visit Northwell.edu. Interested in a career at Northwell Health?
