Director Complex Claims and Counsel

About the role

This position is a high impact role responsible for cost effective and successful management of complex, potentially high exposure claims while providing legal counsel on risk management, claims and litigation matters across Banner Health (BH).

Responsibilities

• Manages claims and litigation cases, proactively monitors and collaborates with outside defense counsel.
• Serves as in-house counsel on risk management and claims matters.
• Designs and directs the claims investigation process; evaluates each claim with respect to liability (standard of care -SOC), causation and damages.
• Maintains a diary system to monitor all open claims.
• Updates claim files per documentation guidelines.
• Apprises Sr. Director, Claims & Litigation Counsel of case developments as appropriate.
• Obtains settlement authority as established by policy.
• Within delegated authority limits, independently negotiates or directs the negotiation of the claims/lawsuits to resolution.
• Represents facility, physician, and or BH at case evaluations, pre-mediation meetings with families and mediators, mediations and trial.
• Notifies reinsurer of selected claims according to established criteria and provides file updates pursuant to reporting guidelines.
• Responsible for determining amounts of liens, rights of recovery and rights of reimbursement with regard to Medicare Secondary Payer Act, other state, federal, and private third-party payers and adheres to all state and federal laws, rules and regulations.
• Provides legal advice and counsel to employees and leadership relating to risk management issues, risk mitigation issues, and settlement and litigation strategies.
• Retains approved defense counsel on a per claim basis after checking conflicts.
• Reviews and approves the defense counsel fees and litigation expenses.
• Presents comprehensive information at internal claim reviews and prepares case review material.
• Provides periodic feedback to staff regarding expectations and performance and completes the performance evaluation process for assigned staff.
• Directs interviews and hiring process, creates and implements orientation plan, provides guidance to new associates and evaluates progress to plan.

Requirements

• Completion of a Juris Doctorate (J.D.) and admission to at least one state bar, and a minimum of eight to ten years medical professional liability management experience, either as an in-house claims professional or outside counsel.
• Strong negotiating skills and a working knowledge of medical terminology are required.
• Strong analytical skills are necessary as well as the ability to organize and communicate information both orally and in writing with all levels of the organization.
• Initiative and the ability to handle responsibility independently are necessary; must have the ability to deal with conflict in a non-confrontational manner and possess the ability to handle sensitive situations and information in a calm mature manner.
• Ability to meet deadlines and to respond to shifting priorities is necessary.
• Must be comfortable operating in a collaborative, shared leadership environment.
• Must be able to adapt to frequently changing work priorities, as well as to work under pressure.
• Must be able to travel to various BH sites or other locations for litigation management purposes up to 50% of the time.
• Must be able to travel to meet with other related parties at various locations is expected.

Qualifications

• Minimum qualifications: Completion of a Juris Doctorate (J.D.) and admission to at least one state bar, and a minimum of eight to ten years medical professional liability management experience, either as an in-house claims professional or outside counsel.
• Preferred qualifications: Nursing degree or other clinical background, advanced knowledge of healthcare claims, risk management, insurance, quality management and performance improvement, prior managerial experience within a healthcare system setting or other large multi-operational, complex corporate environment.