Career Center

Department Overview

Under the direction of the Vice President of Risk Management or his/her designee, this position is responsible for processing and adjusting claims and litigation related to hospital professional liability (HPL) and other lines of coverage as appropriate. In addition, under the direction of the Vice President of Risk Management or his/her designee, this position is responsible for providing loss prevention education and training, risk mitigation advice, investigation and analysis of the frequency, severity and causes of adverse events. These responsibilities are to be performed with the objectives of minimizing losses to the assets of the entire OHSU system from patient-safety related events, and analyzing adverse events to identify patient safety improvement strategies.

Function/Duties of Position

• Maintain assigned claim files, which includes the following components: Identify type and status of claim.
• Prepare claim file setup.
• Conduct detailed investigation.
• Select and monitor defense counsel, if needed.
• Review claims for purposes of evaluating coverage, liability, damages, and claims/litigation management strategy.
• Monitor ongoing medical treatment or patient's recovery.
• Establish and apply value/quality standards to assess the performance of and supervise third party vendors (defense counsel, consultants, etc.) in the event they are engaged for purposes of individual claims.
• Maintain claims performance standards to assure timely response to and resolution of claims, and timely documentation of claims activities.
• Negotiate timely and appropriate settlements with claimants, insureds, employees, attorneys and insurance companies within authority.
• Ensure compliance with Medicare/Medicaid guidelines as related to claims.
• Report to regulatory agencies as required.
• Report potential claims, claims, and lawsuits meeting reporting criteria as established by insurance policy to excess carrier representatives.
• Attend provider meetings, expert meetings, depositions, mediations, arbitrations, trials and other court room proceedings as necessary.
• Present cases to review committees.
• Review, approve and process claims-related legal fees and expenses, and claims-related indemnity payments.
• Explain OHSU policies, claims processed and procedures to OHSU staff, external counsel and insurers.
• Maintain ongoing communications with all claimants, insureds, defense counsel, and insurance carriers.
• Make decisions and judgments regarding claim/litigation strategy, including identifying matters suitable for early resolution.
• Identify, initiate and manage opportunities for subrogation, reimbursement and recovery of claim payments as appropriate.
• Respond to individual risk management and quality assurance questions from OHSU employees. Serve on assigned committees, task force or work groups, and other interdepartmental efforts to consult on quality assurance and patient safety measures and opportunities for improvement.
• Identify patient safety improvement strategies and consult on the design of new quality assurance elements and systems, which includes the following components: Track, analyze and report on claims data to assist with identification of frequency, severity and causes of adverse events and share reports with peer review and quality assurance bodies for use in patient safety efforts.
• Create and present loss prevention training and education at the request of healthcare leadership for faculty, residents and students.
• Maintain positive, professional relationships with all internal and external customers. Keep abreast of current customer needs and current industry trends.
• Meet established goals, demonstrate dependability, promote positive customer service, and demonstrate teamwork/management control, judgment, decisiveness and technical ability in performance of all assigned tasks.
• Other tasks as assigned.

Required Qualifications

• JD degree and 3 to 5 years of experience in professional liability or claim management of medical malpractice litigation, or an equivalent combination of training and experience related to claims management and work in the healthcare field.
• Practices active listening.
• Creates a climate in which people do their best.
• Invites input from each person.
• Allows people to be responsible for their work.
• Creates a feeling of belonging in the team.
• Defines success in terms of the whole team.
• Creates strong morale and spirit in his/her team.
• Relates well to all kinds of people.
• Creates an environment that supports diverse perspectives, approaches and thinking. Communicates clearly.
• Can accurately restate the opinions of others even when he/she disagrees.
• Can facilitate effective brainstorming. Involves team members in critical deliberations and decisions.
• Measures and monitors the degree to which his/her customers' needs are met or exceeded in order to recommend areas for improvement.
• Focuses on meeting the expectations and requirements of internal and external customers.
• Rewards risk taking and accepts outcomes different than expected results.
• Works to maintain alignment of personal area of responsibility to the whole institution.
• Makes decisions in a timely manner, sometimes with incomplete information and under tight deadlines and pressure.
• Clearly and comfortably delegates both routine and important tasks and decisions. Trusts people to perform their jobs.
• Clearly assigns responsibility for tasks and decisions. Uses resources effectively and efficiently.
• Takes prompt and effective action when inappropriate behavior or poor performance occurs.
• Provides current, direct, complete and actionable positive and corrective feedback to others. Monitors workloads and appreciates extra effort.
• Pushes self and others for results.
• Discusses career goals with each person. Seeks opportunities for self-learning and development.
• Can handle stress and the unexpected.
• Can present the unvarnished truth in an appropriate and helpful manner.
• Keeps confidences.
• Demonstrates tolerance and adaptability when dealing with ambiguous situations. Conveys optimism and is positive.
• Ability to work as part of a team, in collaboration with team members.
• Investigation skills to evaluate and appropriately resolve claims.
• Familiarity with medical and insurance terminology.
• Correct language usage, grammar, spelling, punctuation and vocabulary.
• Ability to exercise good judgement, tact and sensitivity.
• Review and address large number of claim documents and forms under time constraints.
• Demonstrate organizational and analytical skills.
• Compile and prepare reports and correspondence.
• Operate standard office equipment including computers and related software applications.
• Plan and organize work, meet schedules and timelines, maintain records; Read, interpret, apply and explain rules, policies, procedures and regulations.
• Ability to resolve internal and external customer complaints and concerns.
• Ability to communicate clearly and effectively, both verbally and in writing.

Preferred Qualifications

Oregon Bar, Paralegal Associate Degree or Certificate, RN, CPHRM, ARM, and/or Washington Bar

Additional Details

• Variable work hours, call coverage, possibly some patient contact.
• Telecommute full time.
• Ability to move around OHSU campus in a timely manner including the use of the aerial tram.
• Extended computer usage, multiple hours/day.

All are welcome