Senior Claims Litigation Management Specialist

We are honored to have earned Great Place To Work® Certification™ for a third year in a row. This recognition reflects the dedication, expertise and compassion of our team members, who make Banner Health a great place to work.

About the Role

This position supports the Litigation and Claims Management function of Banner Health’s self-insurance program. You will compile, review, analyze, and summarize documentation and evidence necessary to investigate claims not in litigation and assist in compiling necessary documents and other evidence in litigated matters including medical professional liability, employment liability, and general liability matters. This role assists Claims Directors and outside counsel with subpoenas, discovery, litigation holds, and coordinating discovery, witnesses, and non-suit depositions. You will perform a variety of complex legal and administrative duties with a high degree of skill and accuracy, working both independently and collaboratively with outside defense counsel and Claims Directors.

This position is remote, with a preference for Arizona residents. The schedule is Monday – Friday daytime, with opportunities to work from home and no after-hours or weekend call.

Responsibilities

• Collects, reviews, analyzes, and summarizes documentation and evidence including medical records, billing statements, policies and procedures, staff schedules, hospital census sheets, equipment-related information, and lien information for claims, pre-litigation, and litigated matters.
• Responds to subpoenas and requests for records related to civil or criminal matters.
• Coordinates witnesses and resources for non-suit depositions.
• Assists with scheduling and attending site visits for outside counsel or consultants reviewing medical records, equipment, or facilities.
• Identifies applicable insurance policies and determines employment or contractual status of relevant parties.
• Identifies relevant physician and non-physician contracts and provides information to Risk Management regarding system contracts, employment status, and expert curriculum vitae.
• Ensures compliance with company policies, state and federal regulations, including Business Associate Agreements, Stark, and HIPAA.
• Identifies key players and search terms for Legal Hold purposes.
• Researches and reviews appropriate court venue dockets in state and/or federal court.
• Reviews, analyzes, and oversees drafting of responses to preservation requests and legal holds.
• Issues legal holds, monitors compliance, and releases holds upon matter resolution at the direction of legal counsel.
• Serves as Risk Management’s liaison to other functions and business units on document and discovery management.
• Provides consultation and leadership in electronic discovery (e-discovery) efforts involving computer software databases.
• Works with IT and other departments to coordinate collection processes and capture responsive Electronically Stored Information (ESI) data.
• Maintains familiarity with documents and issues involving claims, pre-litigation, and litigation to assist in collection, completion, and distribution of discovery documents, billing statements, and medical records.
• Organizes and tracks submitted information and recommends additional collection to facilitate drafting discovery responses.
• Procures and provides Risk Management files and pertinent documentation to Claims Directors and/or outside defense counsel, assisting in preparation of discovery responses.
• Obtains and enters data into the Risk Management Information System (RMIS) and maintains documents to ensure an organized, current case file.
• Monitors data to comply with Section 111 of the Medicare, Medicaid, SCHIP Extension Act (MMSEA) reporting requirements.
• Monitors compliance with Medicare Secondary Payer (MSP) Act requirements, recording and tracking CMS information in RMIS.
• Maintains a litigation calendar, including subpoena due dates, deposition dates, and appearance dates.
• Maintains a library of documents including policies, Medical Staff Bylaws, employee rosters, curriculum vitae, and Settlement Releases.
• Opens claim files in the RMIS database when requested.
• Assists in the initial review and assessment of claims, pre-litigation, and litigation matters.
• Requests and reviews pertinent information to support damage claims, such as lien information.
• Submits necessary information to consultants/experts for review.
• Collaborates with Claims Directors regarding claim disposition.
• Drafts Settlement Release documents, including MMSEA, MSP language, and National Practitioner Data Bank Reports.
• Engages in extensive interaction with senior management, physicians, CEOs, internal management, attorneys, insurance companies, and business personnel regarding medical malpractice and discovery processes.

Requirements

• Strong knowledge of healthcare, litigation, business, and/or law, typically obtained through a bachelor’s degree in a related field.
• Strong organizational and analytical abilities with the capacity to interpret internal policies, medical information, and complex state and federal regulations.
• Ability to prioritize multiple projects, coordinate large volumes of data, and meet court-imposed deadlines with limited supervision.
• Strict adherence to confidentiality requirements.
• Effective oral and written communication skills and the ability to work well as part of a team.

Preferred Qualifications

• Paralegal experience in a defense medical malpractice litigation context.
• Registered nurse with clinical experience.
• In-house claims or risk management experience.