CLAIMS AND INSURANCE SPECIALIST

Overview:

The Claims and Insurance Specialist demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant and the commitment to Extraordinary Care for Every Generation. This individual provides the institution with policies, procedures and guidelines to protect the institution against loss, including those intended to reduce losses associated with patient, employee, or visitor injuries; proper loss or damage; hospital policies and other sources of organizational liability or may result in the filing of lawsuits. To fully integrate with the quality department and improving organizational performance using PDCA. Insurance/Risk Financing, Critical Incident and Improvement Reporting, Claims Management, Legal Interface, Educational In-services.

Responsibilities:

Responsible for maintaining the hospital's insurance coverages making certain appropriate coverage is in place, monitoring insurance premiums, completing applications and yearly renewals, working with various departments within the organization to gather the information necessary so that the hospital is fully insured Maintain positive relationships working with our agents/insurers Manage claims against the facility to include investigations and determinations of liability, reports to insurers, maintaining legal files reflecting chronology of events, maintain and provide quarterly updates on all claims to the Board Case Review Committee, responsible for reporting potential claims to insurers Work closely with defense legal counsel, fulfilling requests for records, arranging interviews with staff and physicians attending case facilitations and represent the hospital at trials Review and record all reported incidents working with outcomes coordinator to track and trend, investigate those incidents needing following up, coordinate process improvement teams as necessary, participation in sentinel event teams Live Covenant HealthCare's "WE CARE" values at work (Working Together, Excellence, Customer Service, Accountability, Respect, Enthusiasm) Support Covenant's Mission statement: …a commitment to an accessible, comprehensive health care network… Keep your focus on Covenant's Vision statement: "A promise of caring…A commitment to service." Maintains department budget by efficiently managing the use of time, equipment, and supplies

Qualifications:

Education/Experience Minimum bachelor's degree - Or willingness to complete within two years At least two years prior Risk Management experience preferred Risk Management certification preferred Knowledge/Skills/Abilities Demonstrates excellent customer service skills Excellent analytical skills Strong computer skills with proficiency in Word, Excel, and Midas Excellent interpersonal skills, especially when dealing with angry patients, public, and co-workers Excellent verbal and written skills Knowledge of the hospital health care service sector Knowledge of the fundamental risk management principles as applied to the hospital setting Ability to effectively influence and motivate others Ability to effectively manage multiple projects concurrently Ability to meet timelines/deadlines consistently Ability to independently investigate complaints/claims Ability to handle highly confidential information

WORKING CONDITIONS/PHYSICAL DEMANDS

Ability to maintain punctual attendance consistent with the ADA, FMLA, and other federal, state, and local standards Constant sitting, near vision. Frequent lift up to 10 lbs. Frequent handling, talking, hearing, midrange vision. Frequent depth perception, visual accommodation, color vision. Occasional lift up to 25 lbs. Occasional standing, walking, carrying, climbing, stooping. Occasional twisting, reaching, feeling, field of vision.