CLAIMS AND INSURANCE SPECIALIST

Overview:

The Claims and Insurance Specialist demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant and the commitment to Extraordinary Care for Every Generation.

This individual provides the institution with policies, procedures and guidelines to protect the institution against loss, including those intended to reduce losses associated with patient, employee, or visitor injuries; proper loss or damage; hospital policies and other sources of organizational liability or may result in the filing of lawsuits. To fully integrate with the quality department and improving organizational performance using PDCA. Insurance/Risk Financing, Critical Incident and Improvement Reporting, Claims Management, Legal Interface, Educational In-services.

Responsibilities:

Responsible for maintaining the hospital’s insurance coverages making certain appropriate coverage is in place, monitoring insurance premiums, completing applications and yearly renewals, working with various departments within the organization to gather the information necessary so that the hospital is fully insured

Maintain positive relationships working with our agents/insurers

Manage claims against the facility to include investigations and determinations of liability, reports to insurers, maintaining legal files reflecting chronology of events, maintain and provide quarterly updates on all claims to the Board Case Review Committee, responsible for reporting potential claims to insurers

Work closely with defense legal counsel, fulfilling requests for records, arranging interviews with staff and physicians attending case facilitations and represent the hospital at trials

Review and record all reported incidents working with outcomes coordinator to track and trend, investigate those incidents needing following up, coordinate process improvement teams as necessary, participation in sentinel event teams

Live Covenant HealthCare’s “WE CARE” values at work (Working Together, Excellence, Customer Service, Accountability, Respect, Enthusiasm)

Support Covenant’s Mission statement: …a commitment to an accessible, comprehensive health care network…

Keep your focus on Covenant’s Vision statement: “A promise of caring…A commitment to service.”

Maintains department budget by efficiently managing the use of time, equipment, and supplies

Qualifications:

Education/Experience

Minimum bachelor’s degree – Or willingness to complete within two years

At least two years prior Risk Management experience preferred

Risk Management certification preferred

Knowledge/Skills/Abilities

Demonstrates excellent customer service skills

Excellent analytical skills

Strong computer skills with proficiency in Word, Excel, and Midas

Excellent interpersonal skills, especially when dealing with angry patients, public, and co-workers

Excellent verbal and written skills

Knowledge of the hospital health care service sector

Knowledge of the fundamental risk management principles as applied to the hospital setting

Ability to effectively influence and motivate others

Ability to effectively manage multiple projects concurrently

Ability to meet timelines/deadlines consistently

Ability to independently investigate complaints/claims

Ability to handle highly confidential information

WORKING CONDITIONS/PHYSICAL DEMANDS

Ability to maintain punctual attendance consistent with the ADA, FMLA, and other federal, state, and local standards Constant sitting, near vision.

Frequent lift up to 10 lbs.

Frequent handling, talking, hearing, midrange vision.

Frequent depth perception, visual accommodation, color vision.

Occasional lift up to 25 lbs.

Occasional standing, walking, carrying, climbing, stooping. Occasional twisting, reaching, feeling, field of vision.