Northwell Health Claims Counsel - Risk Mgmt (Med Mal) in Great Neck, New York

Req Number 001EY1

Job Category Legal/Corporate Compliance/Risk Management

Job Description

As the Claims Counsel, you will participate in the management of a Claims Management Program including, but not limited to Professional Liability, Employment Practices Liability, and Directors' & Officers' Liability. In this role, you will manage a caseload of claims as assigned. You will prioritize and monitor claims filed; evaluate insurance coverage; ensure reporting of claims to primary and excess insurance; conduct and/or manage claims audits; evaluate and monitor reserves; and oversee defense counsel.

Responsibilities include :

  1. Manages a comprehensive, integrated system for managing non-workers' compensation claims for the health system and its affiliates:
  • Manages a caseload of assigned claims.

  • Ensures reporting of claims to insurance carriers.

  • Conducts insurance coverage analyses.

  • Reviews and evaluates insurance carrier coverage responses including reservation or rights and coverage denials.

  • Evaluates loss runs to ensure adequate reserving of claims at all layers of primary and excess coverage.

  • Oversees Third Party Claims Administration (TPA) and defense counsel in the management of all aspects of assigned claims including day-to-day management, case reserves, expenses and motion practice.

  • Maintain current claim information in the database.

  • Ensures appropriate expert reviews.

  • Evaluates claims focusing on exposure, severity, reserves and trial dates.

  • Monitors cases on trial and attends trials, when necessary.

  • Identifies cases requiring early/pre-trial resolution.

  • Collects and reviews claims data to identify trends and opportunities for loss control.

  • Collaborates with risk management to recommend loss control initiatives.

  1. Serves as a liaison between the health system, Third Party Claims Administrator and Insurance Broker in all aspects of claims management.

  2. Monitors claims impacting on the health system's Insurance Captive Insurance company, Self Insurance Program and/or deductibles,

  3. Reviews insurance and related provisions of written agreements.

Qualifications

  • Juris Doctorate degree.

  • Minimum five (5) years related progressive experience in Professional Liability Litigation and/or Healthcare Claims Management. Clinical nursing background, preferred.