Home / Liability Claims Specialist

Liability Claims Specialist


Company

Lancaster General Hospital

Cost Center

3085 Risk Management

Supervisory Organization

Risk Management Support

Grade

G14

Summary

HOURS: 8:30am - 5:00 pm M-F; no weekends/holidays.

POSITION SUMMARY: Provides claims advisory and administration services for Lancaster General Health/Penn Medicine and Lancaster General Insurance Company, Inc. (LGIC).  Maintains deep understanding of all known potentially compensable events facing the organization, and keeps all stakeholders informed.  Manages the litigation process to ensure compliance with State law (and other authorities) and ensures litigation deadlines are met in order to minimize risks involved in any given claim.  Supports and coordinates all activities related to claims and LGIC.

ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:

  • Acts an administrator of litigation that falls under the LGIC Captive reinsurance program. 
  • Studies all known potentially compensable events and advises appropriate parties regarding risks, and developing patterns.
  • Serves, in collaboration with Risk Managers, internal and external counsel, as a litigation expert for all employed physicians, and Advanced Practice Providers (APPS) and staff and will work and interact closely with leadership in managing liability claims.
  • Has dual reporting structure and reports to Risk Department Manager for administrative concerns, and to the Vice President of Risk Management and Corporate Compliance on matters related to claims, such as for strategic direction, or to inform of material changes. 
  • Regularly interfaces with outside defense legal counsel.  Ensures internal standards are met by Counsel, such as biannual lawsuit reports.
  • Records, collects, documents, maintains, and provides counsel with any requested information and documents necessary to prepare testimony in pending litigation.
  • Occasionally participates in pretrial and trial activities.
  • Develops written investigational summaries including medical record summaries, letters to defense counsel; interview summaries and updates. 
  • Oversees the preparation of materials to be distributed to the Captive Claims Committee.
  • Updates and maintains all lawsuit files, and schedules and coordinates external audits of same.
  • Responsible for ensuring notification of all appropriate parties of new lawsuits, or significant changes in claims including Lexington and all reinsurers.
  • Ensures notification of the MCare Fund and appropriate State authorities when lawsuits are served.
  • Facilitates completion of discovery requests related to lawsuits, and works in conjunction with Risk Managers and Insurance Coordinator as needed to obtain information in support of discovery.
  • Responsible for tracking and trending claims data, and for providing aggregate data to the Manager of the Risk Department.
  • Responsible for the flow of funds in the event of verdicts or claims settlements.  Coordinates all efforts between the LGIC Inc. manager, the fronting company, Lexington, and LGH to ensure timely payment of claims. 

SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:

  • Facilitates reporting to the National Practitioner Databank as applicable.
  • Maintains professional growth and development through educational programs and in-service meetings.
  • Primary system administrator for Claims Management software
  • Secondary/back up system administrator for Incident Reporting System for Risk Department.
  • Acts as system administer for the Incident Reporting System for the Risk Department
  • Performs other duties as directed or as necessity dictates.
  • Other duties as assigned.

JOB REQUIREMENTS

MINIMUM REQUIRED QUALIFICATIONS:

  •  Bachelor degree in related field.
  • Certified Paralegal or a minimum of 2 years’ experience in handling liability insurance claims.
  • Two (2) years of experience in healthcare risk management. 
  • Experience performing medical record reviews.
  • Experienced in summarizing and aggregating information and data.

PREFERRED QUALIFICATIONS:

  • Experience in patient care, patient safety and quality, risk management, strongly preferred.
  • Legal claims management experience desirable.
  • Experience with the Epic electronic health record is desirable.
  • Advanced level of understanding of Microsoft Office software including: Outlook, Word, Excel, and PowerPoint.
  • Strong written and oral communication skills, attention to detail, strong organizational skills.

LGH Full Time Posted on 09/04/2019