Director of Claims and Litigation

Position Summary

This position is responsible for strategizing and implementing a cost-effective and successful process to manage Hospital and Physician Professional Liability (HPPL), General Liability (GL) and Employment Practices Liability (EPL) claims and litigation and co-manages other insured and uninsured litigation across the Banner Health (BH) system upon request.

Core Functions

• Knows, understands, incorporates and demonstrates the mission, vision, values, brand, strategic initiatives, core measures and core behaviors into leadership behaviors, practices and decisions.
• Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards.
• Provides all customers of BH with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.
• Formulates and implements a thorough investigation plan for each claim.
• Evaluates each claim with respect to standard of care, liability, causation, and damages.
• Determines whether a preservation hold has been or needs to be issued.
• Considers witness credibility and consultants/expert opinions and determines the value of the claim.
• Determines and sets appropriate indemnity and expense reserves in a timely manner and periodically re-evaluates such reserves.
• Maintains a diary system to monitor all open claims.
• Updates claim files per documentation guidelines.
• Apprises Director of Claims and VP Business Health 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 obtaining, entering data into claim file and monitoring such data in order to comply with deadlines for meeting Medicare, Medicaid, Ship Extension Act (MMSEA) reporting requirements in relation to claimants and others releasing medicals.
• 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.
• Participates in the attorney selection and re-evaluation process with the Director of Claims and VP Business Health.
• Retains approved defense counsel on a per claim basis after checking conflicts.
• Directs and supervises the work of outside defense counsel pursuant to litigation protocol.
• Reviews and responds to attorney inquiries, reports and recommendations as appropriate.
• Reviews and approves the defense counsel fees and litigation expenses.
• In conjunction with defense counsel establishes a claim resolution strategy, facilitates and communicates same.
• Provides guidance and clarity to other team members relating to litigated matters.
• Presents comprehensive information at internal claim reviews and prepares case review material.
• Provides status reports for both open and closed claims to facility Risk Managers, facility administrators, committees and other as requested.
• Responsible for creating, monitoring and updating policies and procedures for the VP Business Health.
• Identifies loss control issues and makes recommendations as appropriate.
• Documents risk modification and risk reduction strategies in claims file and in database.
• Works collaboratively with the risk managers to identify risk management trends, issues and opportunities.
• Responsible for cultivation of BH Insurance Program.
• Participates and presents at introductory meetings with potential insureds; prepares materials, participates and presents at Banner Medical Group (BMG) meetings, committees and other organizational structures and at other physician program meetings as established and as appropriate; provides education relative to the program across BH.
• Directs and supervises Litigation Management Specialists/paralegals and Information Analyst/s in handling of claim files, creating reports, database entries and other claim management responsibilities.
• Provides periodic feedback to staff regarding expectations and performance and completes the performance evaluation process for assigned Information Analysts.
• Directs and supervises the Information Analysts in maintaining and updating database and reviews at appropriate intervals to promote data integrity.
• Investigates and evaluates claims and manages such claims through mediation and/or trial.
• Requires extensive interaction with all levels of senior management, physicians, CEO’s, internal management, other BH personnel, attorneys, mediators, insurance companies and business personnel.
• Has independent authority to resolve claims on behalf of Banner Health.

  Minimum Qualifications

  • A 4-year undergraduate degree or equivalent related experience is required.
  • A clinical health care degree and or graduate degree in law or hospital administration are strongly preferred.
  • Six to ten years experience as a liability claims professional adjuster, defense malpractice attorney or hospital risk manager is necessary, and strong negotiating skills are preferred.
  • Advanced knowledge and working relationships in risk management, quality management and performance improvement is helpful.
  • Working knowledge of medical terminology is 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.
  • A personal presence which is characterized by a sense of honesty, integrity and caring with the ability to inspire and to motivate others to promote the philosophy, mission, vision, goals and values of BH is essential.

  Preferred Qualifications

  • Additional related education and/or experience preferred.