Manage claims for property, general liability, cyber and other coverages as assigned. Claims management includes: reporting to carriers and internal partners, system maintenance, detailed claims investigations, establishing and evaluating reserves regularly, selecting and monitoring defense counsel, conferring directly with claimants, attorneys, physicians, employees, brokers, carriers and consultants; settling claims with merit; selecting and utilizing auditing firms, as needed and/or required. Ensure that all regulatory reporting and insurer/reinsurer reporting is completed accurately, appropriately, and in compliance with standards. Establish, maintain and review reserves for each claim throughout the life of the claim file based upon thorough investigation, evaluation and insurance industry standards. Devise, develop, implement and maintain claims management systems and reporting systems that minimize risk of loss to the organization and promote effective and systematic resolution of claims against OHSU and its employees. Monitor claims to disposition. Explain OHSU policies, claims processes and procedures to OHSU staff, external counsel, and insurers.
Review OHSU contracts for insurance and indemnification compliance and adherence to current insurance policies and risk to the organization. Consult with OHSU departments or other external roles with regard to contract language, documentation, or other issues pertaining to insurance coverage, evidence of coverage, loss prevention processes, risk reduction strategies, cost allocation strategies or other programs aimed at reducing the cost of and risk of losses to the organization. Provide risk analysis related to contract terms for escalation to leadership for business decisions. Support contracting units on training and process improvement initiatives. Describe OHSU insurance policies and coverage related matters to contracting parties.
Ensure insurance policies and all supporting documents are maintained; analyze existing policies for coverage and exclusions; anticipate and prepare for policy expirations. Plan timelines for completion of Property/Casualty and other applications. Work with insurance team to prepare specs for submission to markets. Participate in negotiating policy provisions with insurance carriers and brokers. Identify opportunities to streamline existing processes.
Gather and analyze underwriting data, including loss data; assist in making underwriting recommendations; assist in developing underwriting guidelines; review and analyze loss control reports.
Handles requests from customers for internal & external insurance certificate production, verification of coverage processes. Maintain insurance policies in accordance with records retention policy.
Develop and maintain appropriate internal controls processes for identifying insurable exposures, coverage documentation, and authorized extensions of OHSU insurance/self insurance coverage. Evaluates exposures for all lines of insurance, including but not limited to, property, cyber, general liability, employment practices, and professional liability. Assist with verification that exposures are adequately insured. In the event of loss, conducts an internal investigation and prepares data required by the brokers and carriers. Develop familiarity with insurance markets. Participate on internal committees and working groups to identify potential risks to the organization and advise on insurance coverage implications.
Manage the Off Campus Authorization process to ensure extension of professional liability insurance coverage to all OHSU employed clinicians. Work with partner departments to streamline processes associated with Off-Campus Authorizations. Develop application screening for coverage related issues and compliance with OHSU policies and other regulations. Lead regular system admin meetings to ensure electronic system is up to date and meeting users needs.
Other projects or special projects as assigned.
