Medical Claims Review Manager jobs in New Mexico

Description

Providence caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Providence is calling a Senior Claims Insurance Manager - Medical Professional Liability Claims Handler who will:

• Be responsible for medical professional liability claims and complex general liability claims in accordance with the System's claims program policies and procedures and within an assigned Region or scope of responsibility
• Analyze insurance policy documents to address coverage
• Work with defense attorneys specializing in defense of medical negligence claims
• Be responsible for writing insurance policy coverage letters
• Be responsible for investigating, evaluating and managing professional and other liability claims against the organization
• Maintain up-to-date and accurate claim files, including summaries, action plans, and claims status in the claims data management software
• Communicate directly with patients, claimants, witnesses and families
• Coordinate with facility leadership, risk managers, defense counsel, and others
• Monitor and advise on disclosure and early resolution opportunities
• Ensure compliance with relevant claims reporting procedures and required regulations
• Provide feedback and recommendations, evaluations, litigation trends, department policies and procedures, system-wide claims and litigation processes, and appropriate System risk management issues
• Have direct responsibility to foster teamwork, operational excellence, and effective communication within the claims team, including other Claims Managers, Claims Reps and Claims Specialists

This role is considered to be a remote position and can be worked from the majority of States within the United States.

Please note Providence cannot hire within the following States:

• Colorado
• Hawaii
• Massachusetts
• New York
• Ohio
• Pennsylvania

Required qualifications for this position include:

• Bachelor's Degree in Business Administration, Finance, or another related discipline -OR- a combination of equivalent education and experience
• 7 years relevant general and professional liability claims processing or management experience
• 5 years direct supervisory or management experience

Preferred qualifications for this position include:

• Experience handling Medical Negligence Professional Liability Claims
• Experience handling Complex General Liability Claims
• Experience Investigating, evaluating and negotiating medical negligence claims
• Experience working with defense attorneys specializing in defense of medical negligence claims
• Experience analyzing medical professional and general liability insurance policy documents and addressing coverage
• Experience writing medical professional and general liability insurance policy coverage letters
• STARS / Riskonnect or similar claims management software experience
• Certified Professional Healthcare Risk Management (CPHRM)

Salary Range by Location:

WA: (Puget Sound, Vancouver), OR: (Portland), AK: (Anchorage):

• Min: $51.16
• Max: $82.36

OR: (Salem, Hood River, Medford, Seaside):

• Min: $47.70
• Max: $76.78

E-WA: (Richland, Spokane, Walla Walla):

• Min: $45.53
• Max: $73.29

NorCal (Napa, Sonoma):

• Min: $59.84
• Max: $96.32

SoCal, NorCal (Humboldt), AK: (Kodiak, Seward, Valdez), NV:

• Min: $53.33
• Max: $85.85

MT:

• Min: $41.19
• Max: $66.31

TX, NM:

• Min: $39.02
• Max: $62.82

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.

About the Team

Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Requsition ID: 264545

Company: Providence Jobs

Job Category: Financial Transactions

Job Function: Health Plans Services

Job Schedule: Full time

Job Shift:

Career Track: Business Professional

Department: 4008 SS RIS

Address: WA Renton 2001 Lind Ave SW

Work Location: Providence Southgate 2-Renton

Pay Range: $53.33 - $85.85

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.