Risk Claims Analyst

Position Summary / Career Interest:

The Risk and Claims Analyst provides support to the Risk, Claims, and Insurance Department, in all areas of physician risk, claims administration, and the insurance program. Responsibilities include conducting research, preparing statistical reports, handling underwriting requests, and assisting with obtaining insurance renewal data, processing new claims assuring timely and accurate reporting, and undertaking projects as directed. Must project a professional company image through in-person, virtual, and phone interaction.


Responsibilities and Essential Job Functions

• As delegated by the Directors - represents department management for communicating information to hospital executive team, vendors, physicians, staff, and community agencies.
• Provides support to all aspects of insurance program, i.e., renewal/underwriting requests, certificate of insurance coordination, adding and terming provider coverage and tracking refunds.
• Provides support in handling general liability, property and auto claims; including coordination of claims.
• Coordinates responses to litigation discovery Utilizes database to document matter activities and correspondence.
• Escalates claim concerns to the team.
• Composes correspondence, memos, newsletter pieces, website content, policies, reports: types and proofs materials; edits, collates, assembles, and distributes documentation as needed.
• Prepares reports, activities calendars, mass mailings (i.e., letters and memos for staff).
• Assists with creation of database structure, gathers and analyzes data, and distributes reports as needed to support department operations.
• Demonstrates competencies in computer programs such as: Microsoft Office Word, Excel, PowerPoint, and Outlook, as well as other intra/internet programs.
• Prioritizes correspondence, memos, reports, and internal signature files and appointments; Reviews, classifies, and files correspondence, documents, and materials in main filing system; secures confidential file system dealing with sensitive documentation.
• Assists with the development, implementation and monitoring of the claims management program for the organization
• Participates on various Patient Relations committees such as a Grievance and Appeal committee as a member and consultant
• Serves as a proactive resource to departments and committees to promote safe and quality patient care and reduce liability exposure.
• Exercises professional judgment and critical thinking in facilitating prompt and compassionate claims management.
• Coordinates with the Directors the development and presentation of educational programs on risk management issues and claims trends.
• Promotes the containment of claims and losses, through early identification, assessment and resolution.
• Acts as liaison between the Board of Healing Arts and UKP physicians by serving as point of contact and negotiating submission terms for complaints.
• Assists and participates with the Directors of Claims, Insurance and Risk Management, in early communication and resolution protocol in response to unanticipated negative outcomes of care
• Works effectively with TUKHS Compliance, Risk Management, and other departments to provide information related to claims and insurance.
• Participates in education and orientation of new physicians as requested.
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

• Associates Degree from an accredited College or University.
• 5 or more years broad administrative/project coordination/ or risk, insurance, and claims management in a healthcare environment

Preferred Education and Experience

• Bachelors Degree from an accredited College or University. OR
• Technical/Professional designations and training in Risk, Claims or Insurance/Degree in Business School Training.

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.