<ul> <li>Responsible for the day-to-day functions of the department's self-insured, property and casualty insurance programs, and all other applicable claims functions. </li><li>Work collaboratively with a broad range of internal stakeholders, employees, external defense counsel, consultants, broker, insureds and underwriting staff. </li><li>Ensures accurate and timely claim filing and maintenance of insurance, claims and legal files. </li><li>Manages commercial insurance claims reporting, working with brokers, claims counsel and insurers to ensure timely filing of claims, development of insurance claim documents and timely follow up. </li><li>Communicate with brokers, underwriters, captive management, actuarial and insurance consultants on all claims and insurance matters. Oversee submission of claims, including documentation to support claims, and coordinate all insurance activities with brokers, consultants, and operations staff. Provide reports on claim matters to same. </li><li>Oversees claim reporting, claim adjusting, insurance renewal, and related policy maintenance functions. </li><li>Review insurance application process with other departments, initiate meetings between brokers and staff to provide education in preparation of submission of applications. Participate in broker renewal meetings, develop underwriter presentations, and ensure timely insurance renewal bindings. </li><li>Prepare insurance exposure data and applications for submission to brokers. Gather all required data, work with finance and clinical departments, verify accuracy of data, identify and research any data deviations. </li><li>Responsible for managing and monitoring an $18M+ insurance and related expense budget, with goal of ensuring adequate coverage with strong insurance companies while remaining fiscally responsible. </li><li>Monitor and ensure Stamford Health's compliance with State Insurance Department, Vermont Department of Financial Regulation and MMSEA filings. </li></ul> <p>o This includes preparing and submitting all mandated regulatory reports of closed claims activity to same, which may require working with IT to process.</p> <ul> <li>Manage and accurately update the loss runs on the electronic system based on Claims Committee activity and relevant legal activity. Entry of both new incident and claims data as well as ongoing litigation. </li><li>Manage legal files and prepare accurate records, including accurate filing of all relevant documentation, preparing invoices and accurately filing all related correspondence. </li><li>Prepare draft response of interrogatories and discovery requests on behalf of the Executive Director and Chief Risk Officer. This may require research of relevant policies, records and documentation to provide accurate and timely submission to counsel. </li><li>Promptly and accurately report new claims to all relevant commercial insurance policies. This includes maintenance of loss records, working with hospital staff, underwriters and brokers to ensure timely submission of all relevant supporting documentation and claims adjustment. </li><li>Ensure receipt and filing of all relevant insurance policies, review for completeness. </li><li>Prepare incident reporting summary reports identifying relevant changes in trends and responding to requests for ad hoc reports. </li><li>Accurately maintain all related coverage files for Healthstar insureds. Work with providers and insurance consultant to maintain any evidence of coverage. </li><li>Maintain accurate and up to date policy files for all property and casualty insurance coverages maintained by The Stamford Hospital and Stamford Health System. </li><li>Attend meetings of the Enterprise Risk Management Committee of The Stamford Hospital to facilitate the maintenance of minutes and to provide support for action by the Committee. Assists, as needed, in the coordination of information and data and/or preparing reports and presentations for the HealthStar Indemnity board committee and counsel. </li><li>Prepare meeting minutes, files and telephone work as needed for department staff. </li><li>Participate in relevant committees as needed and determined by the Executive Director. </li><li>Assist in the review and revision of any Department and Hospital Policies as necessary </li><li>Interface with medical records department as necessary to ensure efficient processing of inquiries from regulatory agencies and legal representatives of patients. </li><li>Work with counsel to schedule depositions and meetings with witnesses for pending litigation. </li><li>Investigate and evaluate claims involving Stamford's all-risk property program. Assess claim sites; manage information flow and exchange between insurers/adjusters, brokers, and Stamford Health. </li><li>Develops and maintains computerized programs for claims and insurance data and reports of risk management data and trends for underwriters, board, claims committee, and other organizational departments. </li></ul> <ol> <li>Data Analysis and Reporting: </li></ol> <ul> <li>Develops regular and adhoc reports, provides analysis of reports including, reportable events and claim triggers and manages follow-up with all significant adverse events. Reviews and evaluates aggregate adverse events and claims data, as well as other hospital information to identify high-risk activities, procedures and departments. </li><li>Recommends corrective and preventive actions to reduce risk. Collaborates with system-based improvement teams on interventions. </li><li>Continually evaluates claims management reporting system for potential improvement. </li><li>Prepares and presents reports on Stamford's insurance program, external market trends, claims and reporting trends to organizational committees, medical staff leadership, board committees, and underwriting/insurance representatives as necessary. </li></ul> <ol start="2"> <li> <p>Keeps abreast of changing legislation, standards, and policies that affect insurance and risk management.</p> </li><li> <p>Assists in developing and communicating insurance budgetary needs during the financial planning cycle.</p> </li></ol> <ul> <li>Responsible for maintaining expense levels with the financial plan. </li><li>Responsible for communicating and explaining significant variances as they occur. </li></ul> <p>Other Competencies</p> <p>Performs other related duties as assigned or requested to maintain a high level of service. Completes required continuous training and education, including department specific requirements. Demonstrates professional work behavior by following Service Standards and Success factors. Complies with departmental organizational policies and procedures and adheres to external agency requirements.</p> <p>QUALIFICATIONS/REQUIREMENTS:</p> <ul> <li> <p>Bachelor's degree in business or related field required, Master's degree preferred.</p> </li><li> <p>Experience within the insurance industry, claims management field, and loss control.</p> </li><li> <p>Minimum of three to five years commercial insurance, underwriting, actuarial, insurance placement, or other relevant experience.</p> </li><li> <p>Experience with professional/general liability, commercial, healthcare insurance preferred, including self-insured captives.</p> </li><li> <p>Ability to work with brokers, underwriters, counsel, hospital staff in a positive and professional manner.</p> </li><li> <p>Ability to accurately complete and analyze exposure data, identifying aberrancies and trends that need to be evaluated before insurance application submission.</p> </li><li> <p>Experience in working with teams in a complex organization.</p> </li><li> <p>Previous experience within healthcare risk management a plus.</p> </li><li> <p>Claims adjuster/broker's license or equivalent, or willingness to obtain within 1 year of employment.</p> </li></ul> <p>SKILLS/ABILITIES/COMPETENCIES:</p> <ul> <li>Excellent written, verbal and presentation skills. </li><li>Strong command of data management, risk insurance report development and analysis. </li><li>Strong knowledge of healthcare and insurance terminology. </li><li>Computer literacy, file management, and strong skills in Microsoft Suite (Excel, PowerPoint, Word,) </li><li>Confidentiality and use of discretion is paramount to this role. </li></ul>