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Claims Specialist
Trinity Health. Investigate, evaluate, and resolve Professional Liability, General Liability, and Employment Practices Liability claims .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Professional Liability, General Liability, and Employment Practices Liability claims management, with strong analytical skills and the ability to communicate effectively across all organizational levels. Proficient in risk management strategies and compliance with applicable laws and policies.
Highest-signal resume keywords
Professional Liability Claims ManagementGeneral Liability Claims ManagementEmployment Practices Liability Claims ManagementRisk Management StrategiesMedical Law Terminology
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Claims InvestigationClaim ValuationIndemnity ReservesNegotiation SkillsDocumentation ManagementLoss Control RecommendationsAnalytical SkillsDeadline ManagementOral and Written Communication
Soft Skills
InitiativeResponsibilityCollaborationAdaptabilityOrganizational Skills
Industry Keywords
Risk ManagementQuality ManagementHealthcare ComplianceCMS RegulationsTrinity Health Policies
About the role
Key responsibilities & impact- Investigate, evaluate, and resolve Professional Liability, General Liability, and Employment Practices Liability claims
- Formulate and implement thorough investigation plans for assigned claims
- Evaluate standard of care, liability, causation, damages, witness credibility, and expert opinions
- Determine claim values and set appropriate indemnity and expense reserves
- Establish and communicate claim resolution strategies with defense counsel and claims management
- Obtain settlement authority and negotiate or direct claim and lawsuit negotiations through resolution
- Notify excess insurers and provide file updates according to reporting guidelines
- Maintain a diary system and update claim files according to documentation guidelines
- Present claim information at internal claim reviews
- Represent facilities and/or Trinity Health at case evaluations, settlement conferences, facilitations, mediations, and trials
- Retain, direct, and supervise approved outside defense counsel
- Review attorney reports, recommendations, defense counsel fees, and litigation expenses
- Keep claims management apprised of case developments
- Monitor Medicare Secondary Payer requirements, CMS responses, liens, and settlement-document language
- Identify loss control issues and recommend risk modification and risk reduction strategies
- Collaborate with loss control directors to identify risk management trends, issues, and opportunities
- Adhere to IRMS and Trinity Health policies, procedures, compliance requirements, and applicable laws
Requirements
What you’ll need- Bachelor's degree and experience as a liability claims professional adjuster or hospital risk manager, or an equivalent combination of education and experience
- Knowledge of professional liability, general liability, and employment practices liability claims management
- Clinical health care degree preferred
- Advanced knowledge and working relationships in risk management, quality management, and improvement helpful
- Working knowledge of medical and/or employment law terminology required
- Strong analytical skills
- Ability to organize and communicate information orally and in writing with all levels of the organization
- Initiative and ability to handle responsibility independently
- Ability to meet deadlines and respond to shifting priorities
- Comfort operating in a collaborative, shared leadership environment
- Ability to perform moderate physical activity, lifting, and bending
- Ability to adapt to frequently changing work priorities and work under pressure
Benefits
Comp & perks- Equal Opportunity Employer commitment
- Travel to various Trinity Health sites up to 50% of the time (job-related travel)