Senior Risk Manager / Claims Manager - Hybrid

Responsibilities

The Senior Claims Manager ensures disciplined, timely, and consistent handling of every claim by:

• Serving as the centralized point of contact for all malpractice matters—from intake through closure.
• Managing all insurer communications, including first notice reporting, large-loss notifications, and reserve recommendations.
• Updating each claim every 30 days with: Status summaries, Legal counsel reports, Next steps and expected timelines, Ensuring complete and accurate documentation to support both defense efforts and insurance carrier expectations.

Required Claim Evaluation Checklist

This allows us to maintain predictable financial control and to communicate clear, data-driven positions to insurers and counsel. The checklist addresses:

• Settlement value range and reserve adequacy
• Jury verdict research for comparable cases
• Likelihood of defense success at trial
• Relationship and employment status of co-defendants
• Deductible and annual retention remaining
• Exposure to excess layers and carrier involvement

Investigation & Strategic Oversight

The Senior Claims Manager oversees the strategic trajectory of each claim, including:

• Collecting and analyzing medical records, treatment details, statements, and internal documents.
• Sequestering medical equipment and records as needed.
• Monitoring and challenging litigation strategies to ensure alignment with corporate risk and financial objectives.
• Documenting all investigatory steps, coverage analysis, settlement positions, and final resolutions.

Supporting Our Centers & the Enterprise

This includes:

• Guiding Centers through the claims process and required documentation.
• Providing insight into how each claim affects exposure, reserves, and future premiums.
• Educating leadership teams on emerging litigation trends and best practices.
• Serving as a resource for clinical, HR, and legal leaders when adverse events arise.

Analytics, Reporting & Cost Reduction Initiatives

This includes:

• Identifying systemic patterns in claims (procedure type, provider involvement, documentation gaps, etc.).
• Providing actionable recommendations to reduce future claims exposure and improve clinical processes.
• Developing strategies to reduce ALAE (Allocated Loss Adjustment Expenses) through early intervention, negotiation positioning, mediation strategy, and creative settlement approaches.
• Supporting the insurance renewal process by demonstrating strong internal controls and documented oversight.

Post-Mortem Analysis & Continuous Improvement

For every significant claim that is settled, the Senior Claims Manager conducts a post-mortem review to assess:

• What went wrong clinically, operationally, or procedurally.
• Whether documentation or communication issues contributed.
• Whether early resolution would have reduced cost.
• What corrective actions can prevent recurrence.

Knowledge and Skills

KNOWLEDGE AND SKILLS:

• Detail Oriented - Capable of carrying out a given task with all necessary details to get the task done well.
• Team Player - Works well as a member of a group.
• Self-Starter - Inspired to perform without outside help.
• Excellent communication skills and ability to take a global approach to resolving difficult situations.
• Understanding of financial implications to a company for losses and claims.
• Partnering with carriers and/or third-party claims administrator, counsel, and operators for loss prevention and claims management.

Education/Requirements

EDUCATION/REQUIREMENTS:

• 5-10 years of experience in medical malpractice claims (with either healthcare risk management or insurance carrier), or self-insured public health care company.
• Bachelor's degree in nursing, business, finance and/or economics preferred or equivalent work experience.
• Proficiency in insurance claims management software and systems.
• Familiarity with Microsoft Office Suite (Excel, Word, Outlook) and other productivity tools.

Benefits

Benefits:

• Comprehensive health, dental, and vision insurance.
• Health Savings Account with an employer contribution.
• Life Insurance.
• PTO.
• 401(k) retirement plan with a company match.
• And more!

Environmental/Working Conditions

ENVIRONMENTAL/WORKING CONDITIONS:

• Normal busy office environment with much telephone work.
• Possible long hours as needed.