Claims Specialist

• Provides support to the Risk, Claims, and Insurance Department in physician risk, claims administration, and the insurance program
• Conducts research and prepares statistical reports
• Handles underwriting requests and assists with obtaining insurance renewal data
• Processes new claims, ensuring timely and accurate reporting
• Represents department management when communicating with hospital executives, vendors, physicians, staff, and community agencies
• Supports insurance renewals, certificate of insurance coordination, provider coverage changes, and refund tracking
• Supports general liability, property, and auto claims, including claim coordination
• Coordinates responses to litigation discovery and documents matter activities and correspondence in a database
• Escalates claim concerns to the team
• Composes, edits, proofs, assembles, and distributes correspondence, reports, policies, website content, and other documentation
• Prepares reports, activity calendars, and mass mailings
• Assists with database structure, data gathering and analysis, and report distribution
• Prioritizes, reviews, classifies, and files confidential correspondence and documentation
• Assists with development, implementation, and monitoring of the claims management program
• Participates on Patient Relations committees, including Grievance and Appeal committees
• Promotes safe and quality patient care and reduces liability exposure
• Facilitates prompt and compassionate claims management using professional judgment and critical thinking
• Coordinates development and presentation of educational programs on risk management issues and claims trends
• Promotes containment of claims and losses through early identification, assessment, and resolution
• Acts as liaison between the Board of Healing Arts and UKP physicians regarding complaints
• Assists with early communication and resolution protocols following unanticipated negative outcomes of care
• Works with Compliance, Risk Management, and other departments on claims and insurance information
• Participates in education and orientation of new physicians

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