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Director of Claims

Date:  Jun 12, 2022
Location: 

Dallas, TX, US

Category:  Corporate and Professional Jobs
Job Type:  Day
Requisition ID:  722281

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

 

PRIMARY PURPOSE

Reports to the Vice President of Institutional Risk Management, responsible for the oversight of claims. Scope of claims include workers’ compensation, auto, general, professional liability, cyber, property and all other insured and self-insured matters. In addition, the position is responsible for managing all first party insured, non-litigated and certain plaintiff claims.

 

MINIMUM SPECIFICATIONS

 

Education

  • Must have a bachelor’s degree
  • Master's degree preferred

 

Experience

  • Must have 10 years of relevant experience.
  • Minimum of 3 years’ experience in claims management.
  • Minimum of 3 years’ experience in management.

 

Equivalent Education and/or Experience

  • May have an equivalent combination of education and experience to substitute for both the education and the experience requirements.

 

Certification/Registration/Licensure

  • Must have Federal Emergency Management Administration (FEMA) course certification for IS-700.B: An Introduction to the National Incident Management System (NIMS) or obtain within 30 days of placement in role.
  • Must have Federal Emergency Management Administration (FEMA) course certification for IS-100.C: Introduction to the Incident Command System (ICS 100) for Healthcare/Hospitals or obtain within 30 days of placement in role.
  • Must have Federal Emergency Management Administration (FEMA) course certification for IS-200.HCA: Applying ICS to Healthcare Organizations (ICS 200) or obtain within 30 days of placement in role.
  • Texas All-Lines Insurance Adjuster License preferred.
  • Certified Professional in Healthcare Risk Management (CPHRM) and/or similar Risk Management designations (ARM or CPCU) preferred.

 

Skills or Special Abilities

  • Thorough understanding of Workers’ Compensation, with a focus in Texas healthcare governmental agencies.
  • Working understanding of investigations, subrogation, insurance claims reporting, negotiations, and the closure process.
  • Ability to manage first and third parties’ claims.
  • Ability to efficiently manage Third Party Administrators (TPAs).
  • In-depth understanding of the Texas Tort Claims Act.
  • Working understanding of corporate insurance and risk financing programs.
  • Demonstrate critical thinking, effective communication, and organizational skills.
  • Apply professional judgment to prioritize work to achieve a consistent professional work product and optimal productivity.
  • Ability to establish effective, respectful, and collegial working relationships with internal and external customers including but not limited to patients, physicians, employees, students, visitors, volunteers and vendors.
  • Demonstrate excellent verbal and written communication skills.
  • Proficiency in Microsoft Office.

 

Responsibilities

  1. Develop, implement, and monitor an effective and efficient Claims Management process. Continuously drive excellence to ensure Parkland’s claims program is operating within industry accepted best-practice.
  2. Develop and control an annual budget for Workers’ Compensation, Risk Claims, and office needs. Ensure claim reserves are appropriate and updated timely. Work with third-party actuaries in the annual determination of reserve changes and forecasting.
  3. Manage vendors with a focus on Third Party Administrators (TPA) to ensure contractual expectations are being met and service quality is optimal.
  4. Ensure compliance with local, state, and federal guidelines. With an emphasis on Workers’ Compensation, provide assurance all actions within the administration of claims follow the Division of Workers’ Compensation/Texas Department of Insurance as well as any state agency overseeing workers’ compensation in connection of out-of-state/remote employees.
  5. Delegate administrative responsibilities with a focus on quality outcomes and expense optimization.
  6. Serve as a Thought-Leader as an active member of committees, workgroups, and department liaison in the fields of workers’ compensation, injury metrics, personnel safety, auto/general and professional liability.
  7. Be responsible for accurate and clear reports both internally to Legal Affairs and Risk Management as well as to stakeholders. Be an effective communicator to provide claims insight to stakeholders who are not familiar with risk management terminology.
  8. Manage third party claims to include investigation of allegations, compensability under applicable law, evidence collecting and documenting, denial or approval recommendations, payout process and ultimate closure. Position is responsible for direct communication with claimants.
  9. Serve as a continuous support to staff in the education of the injury on duty process. Serve fellow leaders with guidance and support when staff are involved in the claim process.
  10. Establish and monitor policies and procedures related to injury on duty, patient/visitor property, safe driving, and incident reporting.
  11. Support safety and control initiatives to reduce the likelihood and severity of claims.
  12. Manage staff to include goal setting, performance reviews, quality of outcomes, mentoring and supporting professional growth.

 

Job Accountabilities

  1. Identifies and analyzes the design of jobs, work processes, workflows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of the department and Parkland.
  2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
  3. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.
  4. Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives that have been established for the department.
  5. Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of Parkland.
  6. Selects, trains, schedules, motivates, supervises, and evaluates employees making recommendations for disciplinary actions up to and including termination, to ensure maximum utilization of individual and group capabilities. Ensures that assigned employees receive opportunities to further their knowledge.

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Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.


Nearest Major Market: Dallas
Nearest Secondary Market: Fort Worth

Job Segment: Patient Care, Manager, Healthcare Administration, Healthcare, Management