Job Details

Sr. Professional Liability Medical Claims Manager Remote, Many States Eligible

Providence Health & Services is hiring a Sr. Professional Liability Medical Claims Manager who will investigate, evaluate, and manage professional liability claims under the PSJH Insurance Program. Many states eligible.

Overview

Providence caregivers are valued in a culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. This role supports that mission by managing professional liability and related claims with attention to accuracy, collaboration, and compliance.

Responsibilities

• Communicate with patients, claimants, caregivers, providers, and leadership
• Review and analyze medical records, interview witnesses, assist with the discovery process, and communicate with facility risk managers regarding evaluation and investigation
• Write insurance policy coverage letters and analyze policy documents to address coverage
• Set appropriate indemnity and expense reserves
• Select appropriate medical experts for case review
• Review and approve statements for services and take steps to pay vendors
• Inform Senior Manager Operations of large or complex claims and claims with potential media exposure
• Report claims with potential excess exposure to excess insurers
• Ensure compliance with relevant claims reporting procedures and required regulations
• Work with defense attorneys specializing in defense of medical negligence claims
• Foster teamwork, operational excellence, and effective communication within the claims team
• Develop and document for each claim a plan of action for resolution by settlement, trial, or other means
• Maintain the electronic file with all material communication, correspondence, analysis, expert opinions, interview summaries and other material documents per policies and procedures
• Coordinate with facility leadership, risk managers, defense counsel, and others; obtain authority for settlements or trials as appropriate; participate in case reviews and risk management discussions
• Resolve claims in accordance with policies and regulations; negotiate settlements; monitor trials; report to regulatory agencies as required
• Contribute to department and claims team projects to improve procedures and efficiency
• Provide input on risk reduction and quality initiatives

Qualifications

• Bachelor's Degree in Business Administration, Finance, or related field or equivalent combination of education and experience in insurance, claims management, or legal handling of claims
• 7 years of relevant general and professional liability claims processing or management experience

• Certified Professional Healthcare Risk Management (CPHRM)
• 10+ years of medical malpractice experience
• Insurance carrier experience
• Experience handling medical negligence and complex general liability claims
• Experience with defense attorneys in medical negligence claims
• Experience analyzing policy documents and drafting coverage letters
• Experience with STARS / Riskonnect or similar claims management software

Salary

• Salary ranges vary by location (examples listed in posting): AK, CA, MT, OR, WA, TX, and others

Why Join Providence?

Our best-in-class benefits support you and your family in staying well, growing professionally, and achieving financial security. We are committed to our Mission of caring for everyone, especially the vulnerable, and to empowering our people.

About Providence

Providence is an inclusive, mission-driven health system with 120,000 caregivers serving across multiple states. We offer a comprehensive benefits package and strive to create equal opportunities for advancement.

Equal Opportunity Statement

Providence is an Equal Opportunity Employer. We value diversity and are committed to a inclusive workplace free from discrimination and harassment on any basis prohibited by law.

Additional Details

Requisition ID: 388097 Job Category: Financial Transactions Job Function: Health Plans Services Job Schedule: Full time Workplace Type: Remote