Senior Director, Claims & Litigation Counsel

About the role

This position is responsible for providing strategic and operational leadership to the claims and litigation management team. This includes implementation of best practices, financial responsibility for performance of claims including oversight of claim reserves and outcomes, and providing legal advice and direction related to risk management incidents, potential claims, claims and litigated matters.

Responsibilities

• Provides leadership and direction to ensure cost effective and successful management of liability claims and litigation, including interacting with senior leaders of BH in decision-making on large litigation matters, the handling of claim files, creating reports, database entries, establishing and following standardized claims management procedures and other claims management responsibilities.
• Serves as a role-model for the organization’s mission, vision, values, and behaviors.
• Provides direction and legal advice to Claim Directors and Specialists on claims and litigation matters and is active in management of cases with high potential exposure.
• Establishes and implements standardized excess reporting guidelines and reviews and responds to queries regarding excess carrier reports and loss runs.
• Oversees trial preparation for major claims.
• Within delegated authority limits, independently negotiates or directs the negotiation of the claims/lawsuits to resolution.
• Represents facility, physician, and/or organization at case evaluations, pre-mediation meetings with families and mediators, mediations, and trial.
• Provides legal advice and counsel to employees, leadership, and captive insurer 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.
• Directs privileged investigations.
• Develops, participates in and coordinates internal and external claims audits, and leads claims team roundtable and reserve review processes.
• Makes comprehensive information available at internal claim reviews and status reports to facility leadership, risk managers, facility administrators, medical staffs, various committees, executives and other as requested.
• Participates in the attorney selection and re-evaluation process. Retains approved defense counsel on a per claim basis and directs and supervises the work of outside defense counsel pursuant to litigation protocol.
• Promotes and maintains a culture of continuous improvement and innovation.
• Collaborates with senior leaders and key stakeholders or experts (e.g., Clinical Risk Management, Care Management, including Patient Safety, Legal, etc.) to develop system-wide responses to risk issues that impact specific groups or the entire System with policies/procedures, guidelines, tools, forms, and education/training.
• Participate and present, as directed, at System committees and captive insurance company board meetings and meetings with insureds and insurance underwriters.
• Coordinates and collaborates with other functional areas to assist in developing and/or maintaining programs that promote early identification and reporting of events involving serious injuries or probable liability, and prompt investigation, disclosure, and proactive intervention to resolve potential liability events.
• Develops processes and benchmarks to monitor the effectiveness of risk mitigation strategies.
• Oversees investigation and evaluation of complex claims and manages such claims through mediation and/or trial.
• Negotiates directly with claimants and attorneys on serious liability exposures.
• Supervises and mentors others in the claims management department.
• Responsible for the direction and management of clinical risk management and patient relations.

Requirements

Requires extensive interaction with all levels of senior management, physicians, CEO’s, internal management, other BH personnel, attorneys, mediators, insurance companies, business personnel, and government agencies. Directs attorney-client privileged investigations. Has independent authority to resolve claims on behalf of the organization within established authority levels. Uses specialized knowledge and independent judgment to make operational, financial, and strategic decisions affecting outcomes throughout the company.

Qualifications

• Bachelor’s Degree in a relevant field or equivalent level of education and experience.
• Expert-level working knowledge of principles, practices, and operations in assigned or related area of responsibility as normally obtained through a minimum of five to seven years of progressively responsible managerial experience, including a minimum of two to three years management level experience within a healthcare system setting or other large multi-operational, complex corporate environment.
• This position requires completion of a Juris Doctorate (J.D.) and admission to at least one state bar, and a minimum of five to seven years medical professional liability management experience, either as in-house claims professional or outside counsel.
• Must gain admission to AZ bar through reciprocity or in-house counsel provision.
• Must demonstrate expert-level knowledge and awareness of area of expertise in designated facility, business entity or area and/or experience in which the knowledge, skills, and abilities are directly transferrable.
• Proven track record of driving successful performance outcomes and accomplishing organizational goals.
• Must demonstrate skills and business acumen through direct leadership experiences such as: anticipating and responding to the needs of internal and external customers; managing a budget and financial plans; building partnerships with management, staff, and stakeholders to achieve goals and objectives; managing problems and situations where uncertainty is inherent; persuading others to adopt a particular stance on an issue; developing and evaluating best practices and emerging trends for organizational applicability and appropriateness; constructing new and innovative solutions for complex and varying problems and situations while considering the larger perspective or context; mentoring and coaching staff by providing open and honest feedback to enhance performance; developing and implementing strategic goals and initiatives that support organizational success; demonstrating excellent human relations, organizational and communication skills; and demonstrating a passion for continuously improving and providing high quality care and service excellence to customers, patients, families, employees and/or physicians.