Senior Director Insurance Claims

Senior Director Insurance Claims

The Senior Director, Insurance & Claims manages and oversees Boston Medical Center's insurance program, BMC's captive insurance companies, and the handling of malpractice and general liability claims. The Senior Director collaborates with internal stakeholders, including the Chief Quality Officer and the Chief Financial Officer and their designees, to support loss prevention initiatives and education programs and financing strategies for all lines of insurance coverage. The Senior Director works collaboratively with clinical and business departments, insurance brokers and consultants and advises BMC on insurance strategies to protect BMC Health System.

Position : Senior Director Insurance Claims

Department : Insurance Expense

Schedule : Full Time

Essential Responsibilities / Duties :

• Responsible for the day-to-day operations of BMC's captive insurance companies, insurance programs and communication and coordination with the captive's Board of Directors and service providers. Advises in management and decision-making of captive insurance program company funding, actuarial analysis.
• Directs the claims and litigation program for all lines of insurance coverage, including, but not limited to, self-insured risks and commercially insured risks including medical professional liability general liability, property, auto among others.
• Works closely and collaborates on other matters including employment, cyber, and other related business interruption matters.
• Manages the Claims team who are responsible for handling of medical professional and general liability claims brought against the health system's self-insurance program. Supervises insurance and claims staff, conducts periodic performance appraisals, and recommends personnel actions.
• Ensures the timely reporting of claims; sets and monitors reserves; selects, appoints, and directs legal counsel for insurance claims and third-party claim administrators and oversees defense strategies; maintains appropriate file documentation; and serves as a liaison with insurers on specific claims. Monitors payment of fees for legal counsel for insurance claims and payment of their expenses. Approves payment of legal fees related to covered and non-covered expenses.
• Directs all aspects of insurance management for BMC, including collaborating with the Chief Financial Officer on risk financing strategies for all lines of coverage, collecting information for insurance renewals and actuarial analyses for self-insured retentions, and working with BMC's insurance brokers, consultants, underwriters, and actuaries.
• Collects, evaluates, and maintains aggregate enterprise-wide claims and risk data, partnering closely with analytics and strategy teams to provide regular reports to the captive's Board of Directors, BMC leadership, and various committees.
• Develops and implements systems, policies, and procedures to identify, collect, and analyze claims data.
• Collaborates with Quality & Patient Safety, and participates in clinical, operational, and administrative committees as needed, to provide advice on risk mitigation strategies.
• Establishes or attends other committee meetings as needed to ensure timely reporting of claims information to BMC leadership. These include managing the Claims Committee and Underwriting committees to report on claims and litigation and general risk management matters.
• Directs and supervises claims (loss) history process and requests for certificates of insurance, and evaluates and approves other requests for insurance coverage for BMC's providers.
• Advises on management of risk and required insurance levels in contracts, agreements, leases and other legal documents.
• Actively communicates with health care providers involved in insurance claims on the status of the claim and potential malpractice / professional liability reporting obligations. Works with BMC Medical Affairs Office, Quality & Patient Safety, and Office of the General Counsel to ensure compliance with regulatory requirements for malpractice reporting to the National Practitioner Data Bank and Massachusetts professional boards by preparing timely reports and notifying providers. Reviews cases that may result in major settlements or adverse verdicts with appropriate BMC leadership.
• Performs other duties as assigned.

Job Requirements

Education and Experience :

Bachelor's Degree and 10 years of experience in healthcare risk management, litigation and claims management, and insurance coverage issues or equivalent combination of education and experience.

Preferred Education and Experience : An advanced degree in business, law, or health professions is preferred.

Certifications, Licenses, Registrations Required : N / A

Knowledge, Skills & Abilities (KSA) :

Equal Opportunity Employer / Disabled / Veterans

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