Litigation and Claims Specialist

SUMMARY:
The role is responsible for managing, coordinating, and resolving claims and litigation matters involving the organization. The position involves working closely with internal stakeholders, external counsel, insurers, and other third party administrators to minimize risk exposure and ensure efficient resolution of disputes.

KEY RESPONSIBILITIES:

• Manage and monitor ongoing litigation and claims matters.
• Conduct confidential investigations and draft investigation reports
• Receives and reports on complaints, claims, and potential claims related to professional and general liability.
• Reviews safety event reporting, investigates safety events and claims, and reports to third party administrator as appropriate. Creates privileged written reports.
• Continuously monitors risk hotline and communications.
• Reviews and analyzes legal documents and correspondence related to claims and litigations.
• Prepares internal reports for senior leadership regarding litigation status and claims trends.
• Interfaces with patients and public with respect to liability claims.
• Attends ethics committee meetings and elevates questions to senior leadership.
• Conducts medical chart reviews and prepares written analysis for senior leadership in connection with claims.
• Performs as a liaison between RRH and external counsel, insurers, and claims adjusters.
• Assists in developing legal strategies and evaluating potential liability and exposure.
• Provides training and guidance to internal teams on claims management and risk reduction practices. Provides direct support to care teams with respect to legal questions and patient matters.

PREFERRED QUALIFICATIONS:

• Claims Review experience
• Daily Safety Check experience
• Treat to Target experience
• Claims / Handling investigations experience
• Ethics Master's Degree preferred.
• Bachelors’ Degree preferred

REQUIRED QUALIFICATIONS:

• 3 years of experience in Healthcare, Risk Management, Nursing, Human Resources or a Legal Field or a Bachelor’s Degree required.

REQUIRED LICENSURE/CERTIFICATION:

• Healthcare Risk Management (HRM) or Certified Professional in Risk Management Certification (CPHRM) within 24 months of hire.

EDUCATION:

LICENSES / CERTIFICATIONS: 

PHYSICAL REQUIREMENTS:

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.

PAY RANGE:

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.