Claims Investigator Job at NorthEast Provider Solutions Inc., Valhalla, NY

K1N6YWh5TzZ1bzV6WmRTUkVVZ2w0SWtKR2c9PQ==
  • NorthEast Provider Solutions Inc.
  • Valhalla, NY

Job Description

Job Details:

Job Summary:

The Claims Investigator is responsible for the management and investigation of medical malpractice, general liability and lost/stolen or damaged property claims. This individual will conduct investigations of complex, claims and lawsuits filed against the hospital in preparation for, or in the context of legal action. This position works with considerable independence with a wide scope of knowledge in order to exercise independent judgment within established policies and procedures. This position will also be responsible for related work as required or directed by Risk Management Leadership Team.

Responsibilities:

  • Reviews and analyzes medical records and hospital policies and procedures to identify key issues and assess the hospital’s exposure in preparation for legal action related to a sentinel event or incident that is the subject of a Notice of Claim or Summons;
  • Investigates confidential and complex circumstances that may result in a liability claim;
  • Identifies and interviews named defendants insured through the hospital’s professional liability insurance program and other employed or insured personnel involved in the case;
  • Identifies theories of liability and exposure and involvement of potential co-defendants;
  • Prepares comprehensive and informative investigative reports containing findings, conclusion and recommendations for use by defense counsel;
  • Acts as liaison with defense counsel, assisting with preparation of interrogatories, settlement discussions and preparations of cases for trial;
  • Manages and coordinates the investigation and discovery of claims;
  • Discusses cases with physicians, administrators, attorneys and claimants in a professional and confidential manner;
  • Coordinates in-house medical reviews;
  • Participates in the development and implementation of policies, practices and procedures designed to meet risk management program goals and objectives for efficient and effective claims management to ensure compliance with regulations and codes;
  • Makes recommendations on issues, practices and procedures aimed at limiting long term liability exposure;
  • Develops and conducts programs designed to educate staff;
  • Monitors indemnity / expense ratio;
  • Monitors reserves with written evaluation of high exposure claims in compliance with reporting requirements;
Qualifications/Requirements /

Experience:

Thorough knowledge of claims management functions related to a hospital or health care delivery setting; thorough knowledge of the principles, practices, procedures and techniques utilized in planning and conducting confidential investigations; thorough knowledge of medical malpractice and general liability claims management; good knowledge of the principles and practices of hospital organization as related to the functions of its various divisions, regulatory agencies and accrediting organizations; ability to establish and maintain effective working relationships with a wide range of medical, professional, administrative and clerical personnel; ability to communicate effectively, both orally and in writing; ability to prepare accurate and informative reports; ability to perform work independently and exercise sound judgement within established policies; ability to effectively use computer applications such as spreadsheets, word processing, calendar, email and database software in performing work assignments; ability to read, write, speak, understand and communicate in English sufficiently to perform the essential duties of the position; thoroughness; integrity; tact; initiative; resourcefulness; physical condition commensurate with the demands of the position. Ability to demonstrate flexibility in work assignments and re-prioritize activities to meet department’s needs and expectations. Strong organizational and time management skills are essential to complete time sensitive investigations and reports.

Education:

Bachelor’s degree in Nursing or related field plus three years experience where the primary function of the position was the investigation and/ or analysis of health care related liability claims

Licenses / Certifications:

New York State Education Department Registered Professional Nurse or Allied Healthcare Professional Clinical Background preferred

Other:

Computer skills literacy and familiarity with navigation of electronic medical record systems

About Us:

NorthEast Provider Solutions Inc.

Benefits:

We offer a comprehensive compensation and benefits package that includes:

  • Health Insurance
  • Dental
  • Vision
  • Retirement Savings Plan
  • Flexible Savings Account
  • Paid Time Off
  • Holidays
  • Tuition Reimbursement

 

Job Tags

Holiday work, Full time, Flexible hours,

Similar Jobs

Infirmary Health

Applications Analyst - EPIC (Health Information Management) Job at Infirmary Health

 ...placement into position Desired Qualifications Bachelors degree in health information technology, Computer Science, or related field ~ This position is specific to Epic Health Information Management- Knowledge of Epic Release of Information, Epic Deficiency Tracking,... 

California Rehabilitation & Sports Therapy

Physical Therapy Aide Job at California Rehabilitation & Sports Therapy

 ...As a Physical Therapy Aide at Cal Rehab & Sports Therapy , you'll be an essential part of our team, providing exceptional customer service and administrative support to ensure a smooth and positive experience for our patients. Pay: $16.50/hr Schedule: Part time... 

Ricks on the River

Oyster Shucker Job at Ricks on the River

 ...on the river is looking for an Oyster shucker for a high-volume waterfront restaurant for Friday, Saturday, and Sunday. Experience preferred but not necessary. Hourly wage plus cash tips. Other hours are available if interested in Cooks, Prep Cooks, Dishwasher/Bussers... 

Scheels

Video Editor Job at Scheels

 ...the eyes and minds of our customers, associates, and business partners. Overview SCHEELS is currently seeking a full-time Video Editor for our Fargo, ND Corporate Office. This individual will join our team of Creative Media Marketing associates in developing video... 

Dover Corporation

Corporate Trainer Job at Dover Corporation

Our Story : Dover Food Retail (DFR) is a leading manufacturer of Display Cases, Specialty Products, Refrigeration Systems, Power Systems and Comprehensive Services; and l eading our industry by Innovating Whats Next in glass doors and intelligent merchandising...