Manager Claims & Insurance | Sharp HealthCare | Full time, days_

San Diego

**Facility:** Corporate Offices

**City** San Diego

**Department**

**Job Status**

Regular

**Shift**

Day

**FTE**

1

**Shift Start Time**

**Shift End Time**

Juris Doctor (JD)

**Hours** **:**

**Shift Start Time:**

Variable

**Shift End Time:**

Variable

**AWS Hours Requirement:**

8/40 - 8 Hour Shift

**Additional Shift Information:**

**Weekend Requirements:**

No Weekends

**On-Call Required:**

No

**Hourly Pay Range (Minimum - Midpoint - Maximum):**

$65.550 - $84.580 - $103.611

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

**What You Will Do**

Manager Claims & Insurance manages and supports the defense and resolution of their party liability claims against the system. Manages and supports the insurance program for the system, including purchasing, renewing, claims reporting, preparation and submission of claims reports to various governance committees and the Board of Directors. Assists with organizing captive insurance company meetings.

**Required Qualifications**

+ Juris Doctor (JD)

+ 10 or more years managing third party liability claims for healthcare organization.

+ 10 or more years procuring, renewing, and managing insurance programs.

**Essential Functions**

+ __Supports the management of third-party liability claims__* Assists with management of professional, hospital and general liability claims and litigation for Sharp Healthcare, Sharp Rees-Stealy Medical Group and SharpCare Medical Group in accordance with the Risk Management department policies.* Reviews and recommends insurance policy coverage positions and responds appropriately to carriers.* Assists VP and Insurance Analyst in investigations of liability, damages, and losses relating to the general and professional liability claims of Sharp HealthCare, Sharp Rees-Stealy Medical Group and SharpCare Medical Group.* Conducts witness interviews, attends on-site visits, and depositions at the request of the VP. Accompanies the VP to hearings, mediations, settlement conferences, and trials to ensure appropriate claim resolution.* Accompanies VP in meetings with patients who present with allegations of negligence against the organization and assists with evaluation of liability.* Provides information needed for medical experts to review for standard of care issues. Maintains relationship with each patient until the process has been completed.* Attends monthly claim meetings with Senior Vice-President and General Counsel along with Senior Counsel and Insurance Coordinator to discuss status of cases, resolution plans, and reserves.* Attends quarterly claims meetings of Sharp Rees-Stealy claims with the Chief Medical Officer, President, Quality Director and Physician representative to discuss status of cases, resolution plans, reserves and settlement authority.* Assists with opening claim file for all claims; assigns defense counsel when necessary.* Participates in decisions that determine litigation budget for each open claim.* Takes part in developing and maintaining litigation/resolution plan for all open claims.* Reviews and analyzes relevant QVR data and when appropriate, responds to Sharp HealthCare, Sharp Rees-Stealy and/or SharpCare with a resolution plan.* Supports VP in identifying risk issues arising within the organization and prepares and presents plans for mitigating such risks.* Works with VP and Insurance Analyst to monitor and control defense costs.* Provides claim history verification reports for all Sharp HealthCare, Sharp Rees-Stealy Medical Group, and SharpCare medical group.* Provides Certificates of Insurance for Sharp HealthCare, Sharp Rees-Stealy Medical Group and Sharp Care Medical Group.* Completes case settlement reports for National Practitioner Databank and the Medical Board of California.

+ * Works with VP to manage all insurance issues, including purchasing, renewals, and claims reporting* Assist VP in evaluating and implementing Sharp HealthCare’s insurance programs.* Maintains familiarity with domestic and foreign insurance markets in the healthcare arena* Supports the VP by analyzing and utilizing risk financing alternatives using Sharp HealthCare’s captive insurance company when appropriate.* Supports the VP by helping with administrative duties as required by the Sharp-owned captive insurance company.* Works with the VP in Analyzing and directing the details for the competitive bidding process for all lines of insurance. Helps with annual negotiations with brokers, agents and carriers to guarantee Sharp HealthCare maintains appropriate policies, coverages, premiums, and services consistent with industry standards and the organization’s guidelines.* Supports the VP and Insurance Analyst in recording, authenticating, and maintaining all financial data relating to the captive insurance company.* Reports all claims and litigation against Sharp HealthCare to the appropriate insurance carrier. Provides all information and documentation pursuant to the terms and conditions of each policy.* Understands and recognizes the risks covered and excluded under every policy of insurance.* Supports the VP in analysis of coverage issues relating to all policies.* Provides all data needed to actuarial firms for funding of the self-insured programs.* Assists in developing business insurance budgets for all Sharp entities.* Assists with scheduling and organizing CQI Board of Directors meetings and discussion groups semi-annually.* Works with VP in preparing annual insurance budget for CQI.* Supports VP in preparing annual risk management budget.* Works with VP in purchasing all policies and bonds necessary for new and continuing construction projects.

+ __Works with VP in managing the captive insurance company financials__* Record every expense and indemnity payment made on a monthly basis.* Payments must match exact amount that is recorded by the Finance Dept.* Once payments are recorded and reconciled, loss runs must be sent to Finance, the captive manager, the actuaries, the excess carriers, and other business associates as deemed necessary.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class.

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