Senior Claims Litigation Management Specialist

Primary City/State:

Arizona, Arizona

Department Name:

Work Shift:

Day

Job Category:

Risk, Quality and Safety

A rewarding career that fits your life. Those who have joined the Banner mission come from all walks of life, united by the common goal: Make health care easier, so life can be better. If changing health care for the better sounds like something you want to be part of, apply today.

Bring your passion, innovation and critical thinking skills to a cohesive team that leverages knowledge and experience for customer enrichment and strong team performance. The Claims & Litigation Management team prides itself on the ability to value diverse input and effectively adapt priorities to ensure customer and team needs are at the center of decision making in service to all Banner Health entities, costumers and communities.

As a Senior Claims Litigation Management Specialist you will have the opportunity to cultivate an environment of diverse relationships while supporting a culture focused on enhancing processes and maximizing efficiency with the review and management of claims and litigation matters. Paralegal, claims adjustor experience, medical litigation experience is highly preferred. Additionally, your Monday - Friday daytime schedule includes opportunities to work from home and requires no after hours or weekend call. This position is remote , Arizona residents preferred.

POSITION SUMMARY

This position supports the Litigation and Claims Management function of Banner Health's self-insurance program. This position compiles, reviews, analyzes, and summarizes documentation and evidence necessary to investigate claims not in litigation and assists in compiling necessary documents and other evidence in litigated matters including medical professional liability, employment liability, and general liability matters. This position assists Claims Directors and outside counsel with subpoenas, discovery, litigation holds, and coordinating discovery, witnesses and non-suit depositions. Independently performs a variety of complex legal and administrative duties with a high degree of skill and accuracy. Works both independently and under supervision to collaborate with outside defense counsel and Claims Directors to draft responses, collect, collate and summarize information/data with little or no supervision.

CORE FUNCTIONS

1. Collects, reviews, analyzes, and summarizes documentation and evidence including, but not limited to, medical records, billing statements, policies and procedures, staff schedules, hospital census sheets, information related to equipment issues, and lien information pertaining to claims, pre-litigation, and litigated matters for both civil and criminal claims and/or lawsuits. Responds to subpoenas and requests for records which are related to civil or criminal matters. Coordinates witnesses and resources as appropriate for non-suit depositions. Assists with scheduling and attending the site visits as requested or when there may be outside counsel or consultants viewing the medical records, equipment, or the facility.

2. Identifies applicable insurance policies, and determines employment and/or contractual status of relevant parties and/or entities. Identifies relevant physician-related and non-physician related contracts. Provides information to Risk Management Department personnel regarding whether specific parties and/or entities have system contracts; secures copies of applicable contracts, employment status of personnel and curriculum vitae of experts. Ensures compliance with company policies and procedures and applicable state and federal rules and regulations, including Business Associate Agreements, Stark and HIPAA.

3. Identifies key players and key search terms for Legal Hold purposes. Researches and reviews the appropriate court venue docket in state and/or federal court as appropriate. Reviews, analyzes, and oversees the drafting of responses to preservation requests and legal holds. At the direction of legal counsel, issues legal holds, monitors compliance therewith, and issues releases upon matter resolution. Serves as Risk Management's liaison to other functions and other business units on issues relating to document and discovery management. Provides consultation and leadership in relation to electronic discovery ("e-discovery") efforts involving a wide range of computer software databases. Works with IT and other departments to coordinate the collection processes, and capture available and responsive Electronically Stored Information data.

4. Maintains extensive familiarity with documents and issues involving claims, pre-litigation, and litigation matters in order to provide input and assist in all aspects of the collection, completion and distribution of non-litigation and litigation discovery documents, applicable billing statements and medical records. Organizes and tracks submitted information and recommends collection of additional information in order to facilitate the drafting of discovery responses. Procures and provides the Risk Management file and other pertinent documentation to Claims Directors and/or outside defense counsel, and assists in preparation of discovery responses.

5. Responsible for obtaining and entering data into Risk Management Information System (RMIS) file. Saves and maintains documents in RMIS on claims, pre-litigation and litigation matters to ensure an efficient, organized, and document-intensive case file is current and well maintained. Responsible for monitoring such data in order to comply with deadlines for meeting Section 111 of the Medicare, Medicaid, SCHIP Extension Act (MMSEA) reporting requirements in relation to claimants and others releasing medicals. Monitors compliance with Medicare Secondary Payer (MSP) Act requirements including recording and monitoring pertinent CMS information in RMIS to ensure compliance with regulations and reporting.

6. Maintains litigation calendar, to include subpoena due dates; deposition dates, and appearance dates, as required. Maintains library of various documents including archived and active policies and procedures, Medical Staff Bylaws and Rules and Regulations, employee rosters, curriculum vitae of consultants/experts, and Settlement Releases.

7. Opens claim file into the RMIS database when requested. Assists in the initial review and assessment of claims, pre-litigation and litigation matters. Requests and reviews pertinent information to support damage claims, such as lien information. Submits necessary information to consultant/expert for review. Collaborates with Claims Directors regarding disposition of claim. Drafts appropriate Settlement Release documents, to include appropriate MMSEA and MSP language, and National Practitioner Data Bank Reports.

8. Extensive interaction with all levels of senior management, physicians, CEO's, internal management, other company personnel, attorneys, insurance companies and business personnel, with respect to medical malpractice non-litigation, litigation and discovery process.

MINIMUM QUALIFICATIONS

Must possess a strong knowledge of healthcare, litigation, business and/ or law as normally obtained through the completion of a bachelor's degree in a related field.

Must possess or obtain active Notary Public commission within 90 days of hire.

Must possess strong organizational and analytical abilities with ability to interpret internal policies and procedures, medical information, and complex state and federal rules and regulations and summarize such information in written form. Must be able to prioritize multiple projects, coordinate large volumes of data, track and meet court-imposed deadlines, with limited supervision. Maintains strict confidentiality. Requires effective oral and written communication skills and the ability to work well as a part of a team.

PREFERRED QUALIFICATIONS

Registered nurse with active licensure with clinical experience is preferred. In-house claims or risk management experience.

Additional related education and/or experience preferred.

EOE/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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