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Claims Associate - Miamisburg - Risk Management - Full Time - Days

Claims Associate - Miamisburg - Risk Management - Full Time - Days

Kettering Health NetworkMiamisburg, OH, US
10 hours ago
Job type
  • Full-time
Job description

Kettering Health Legal Counsel

Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with high-quality care for every stage of life. Our service-oriented mission is in action every day, whether it's by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.

Reports to and assists Chief Legal Counsel and Director, Network Insurance & Risk with confidential claim data and operation of the KHN Self-Insurance Program. Processes and maintains all legal files pertaining to Hospital Professional and General Liability claims. Performs other duties as assigned.

Job Requirements :

  • Minimum Education : Bachelor's degree preferred.
  • Minimum Work Experience : Two plus years of experience with medical malpractice claims or two plus years of experience with risk management, patient relations or quality assurance matters.

Job Responsibilities :

  • Required Skills : Ability to work effectively, independently and professionally and in a timely manner with highly sensitive and confidential information with leadership at all levels across the network. Proficient with computer, telephone and keyboarding skills. Superior organizational, written and communication skills. Ability to plan, initiate, and carry out responsibilities with a minimum of direct supervision.
  • Provides and handles communication on all KH and KHMG claims.
  • Maintains all KH and KHMG claim information on Assured Claims software system.
  • Maintains confidential KH and KHMG claim files.
  • Communicates with Administration, physicians, retained legal counsel, and staff regarding all KH and KHMG claims.
  • Responds to phone requests and prepare correspondence to legal counsel and insurance carriers as needed.
  • Maintains an understanding of the internal and external environment of KH Risk Management to appropriately respond to questions.
  • Prepares and distribute quarterly loss run reports, semi-annual actuarial reports, and additional reports for, as requested by, KH and KHMG Administration.
  • Submits reports to the State Medical Board of Ohio as required by guidelines.
  • Submits reports to the National Practitioner's Data Bank as required by guidelines.
  • Assists with the sequestering of medical records, equipment, instruments, photographs, and / or physical evidence that are pertinent to potential claims, claims or pending litigation.
  • Assists in coordinating investigatory interviews, deposition prep sessions, depositions, interrogatories, request for document production, and various other meetings for current or possible future litigation on all KH and KHMG claims.
  • Attends and support KH or KHMG staff and retained legal counsel at investigatory interviews, prep sessions, depositions, and court appearances, as requested.
  • Maintains appropriate diary records on all open files for monitoring and management of claims.
  • Investigates incidents related to claims and lawsuits involving KH and KHMG.
  • Prepares quarterly excess liability reports for various excess insurers.
  • Provides as needed HPL / GL claims information for reporting to Centers for Medicare Services (CMS) monthly and quarterly for KH and KHMG claims.
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