Adventist Health

Faith-based nonprofit integrated health system

Liability Claims Program Manager

Claims AdjudicationUpdated on Nov 5

Full-timeRoseville, CA, USA

About the Job

Requirements

A bachelor's degree or an equivalent combination of education and related experience is required.
Seven years of liability claims management experience is preferred.
One year of leadership experience is preferred.
Experience with legal matters and complex litigation is preferred.

Responsibilities

Analyze complex and technically challenging medical malpractice and general liability claims, resolve complex or severe-injury claims, coordinate case management within established standards and industry best practices, manage total claim costs, and provide high levels of customer service.
Determine the tactical approach, resources, schedules, and goals for assigned objectives.
Analyze the nature and extent of investigation needed to evaluate liability and damages; determine whether experts are needed and retain them to evaluate standard of care and damages; develop, update, and execute case-specific investigation plans; and negotiate claim settlements.
Coordinate legal defense by assigning counsel and coordinating investigative support; review attorney invoices and monitor counsel for compliance with organizational policies and guidelines.
Calculate and assign timely, appropriate claim reserves and monitor reserve adequacy throughout each claim's life.
Recommend and implement settlement strategies; involve structured-settlement professionals as needed; and identify opportunities for subrogation, contribution, recovery, and other case-management measures to mitigate total claim costs.
Ensure claim-file documentation is timely and accurate, create initial notices to reinsurers, and provide timely case-status updates.
Perform other job-related duties as assigned.
Receive required vaccinations as a condition of employment and annually thereafter where applicable; medical and religious exemptions may apply.

Desired Qualifications

A master's degree or Juris Doctor is preferred.

Adventist Health Roseville is looking for Sr. Claims Examiner for Full-Time, Day. We are looking for great individual who can work onsite to our location in Roseville, CA

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.

Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary:

Analyzes complex and/or technically challenging medical malpractice/general liability claims and resolves complex and/or severe injury claims. Coordinates case management within established standards and industry best practices. Manages total claim costs while providing high levels of customer service. Receives assignments in the form of objectives and determines tactical approach, resources, schedules and goals.

Job Requirements:

Education and Work Experience:

Bachelor's degree or equivalent combination of education/related experience: Required
Master's Degree or Juris Doctor: Preferred
Seven years' liability claims management experience: Preferred
One year's leadership experience: Preferred
Experience with legal matters and complex litigation: Preferred

Essential Functions:

Analyzes nature and extent of investigation necessary to evaluate liability and damages. Determines the need for and retains experts to evaluate the standard of care/damages. Develops, updates and executes case specific investigation plan and negotiates settlement of the claim. Applies advanced technical knowledge to solve complex problems for a department.
Coordinates legal defense by assigning counsel, coordinates support for investigation. Reviews attorney invoices and monitors counsel for compliance with organization policies and guidelines.
Calculates and assigns timely and appropriate reserves for claims. Monitors reserve adequacy throughout the life of the claim.
Recommends and implements settlement strategies. Involves structured settlement professionals as necessary to maximize settlement and identifies opportunities for subrogation, contribution, recovery and other case management opportunities to mitigate total claim costs.
Ensures claim file documentation is timely and accurate. Creates initial notice to reinsurers and provides timely updates on case status.
Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.

Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

Pay Range: The estimated base pay for this position is $120,077 to $180,115. Additional individual compensation may be available for this role through differentials, extra shift incentives, bonuses, etc. Base pay is only a portion of the total rewards package, and a comprehensive benefits program is available for qualifying positions. Please contact our Talent Acquisition team for more information.

About the Company

Adventist Health

Faith-based nonprofit integrated health system

Adventist Health is a faith-based nonprofit health system with more than 400 sites of care, including 26 acute care hospitals, primarily on the West Coast and in Hawaii. It provides a full range of health services—from primary and specialty care to hospital-based treatments and wellness programs—delivered across an integrated network of clinics, hospitals, and care facilities. Revenue comes from patient services, insurance reimbursements, and government programs, and earnings are reinvested back into communities to improve health outcomes and expand access to care. The organization differentiates itself through its nonprofit, faith-based model and by reinvesting earnings into community health, along with its broad, integrated network that covers preventive, primary, specialty, and acute care. Its goal is to improve health outcomes for the communities it serves and to expand access to high-quality care.

Company size: 10,001+
Company stage: Grant
Total funding: $210K
Headquarters: Roseville, CA
Founded: Not listed

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