Director of 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 and directs outside counsel.
• 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 Senior 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.
• Serves as a trusted advisor to internal clients, building strong, collaborative relationships.
• Provides legal advice and counsel to employees and leadership relating to risk management issues, risk mitigation issues, and settlement and litigation strategies.
• Provides legal advice and direction to the organization with respect to incidents, potentially compensable events, claims, or suits and insurance coverage issues.
• Directs privileged investigations.
• Provides timely, clear and professional communications including written reports, presentations and claim evaluations.
• Presents comprehensive information at internal claim reviews and prepares case review material.
• Provides status reports for both open and closed claims as requested.
• Creates, monitors and updates policies and procedures for the Senior Director, Claims and Litigation Counsel, and VP, Chief Risk Officer & Counsel.
• Identifies risk management 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 and brings those learnings back to the broader organization.
• Provides education and training throughout the system on risk and litigation mitigation strategies.
• Directs and supervises Litigation Management Specialists/Paralegals and Information Analyst/s in handling 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 staff.
• Directs interviews and hiring process, creates and implements orientation plan, provides guidance to new associates and evaluates progress to plan.

Requirements

This position requires 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.

Must gain admission to AZ bar through reciprocity or in-house counsel provision.

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

4-year undergraduate degree or equivalent related experience is required.

Preferred qualifications include a nursing degree or other clinical background, advanced knowledge of healthcare claims, risk management, insurance, quality management and performance improvement, knowledge of in-house liability claims management processes and procedures and other related healthcare regulatory and/or litigation experience, and prior managerial experience within a healthcare system setting or other large multi-operational, complex corporate environment.

Skills

Strong negotiating skills and a working knowledge of medical terminology.

Strong analytical skills.

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.

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.

Comfortable operating in a collaborative, shared leadership environment.

Able to adapt to frequently changing work priorities, as well as to work under pressure.

Able to travel to various BH sites or other locations for litigation management purposes up to 50% of the time.

Able to travel to meet with other related parties at various locations is expected.

Benefits

The posted compensation range is a reasonable estimate that extends from the lowest to the highest pay Banner Health in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. This range is based on possible base salaries and does not include the value of our total rewards package. Actual pay determined at offer will be based on years of relevant work experience, education, certifications, skills, and geographic location, along with a review of current employees in similar roles to ensure pay equity is achieved and maintained.

Pay

Estimated Pay Range: $65.70 - $109.50 / hour

Schedule

Day Shift