The Claims Investigator works under the direction of MHS attorneys and risk management leadership within the MHS Legal Affairs Department. This position researches law, investigates facts and records, and prepares documents to assist the MHS Legal Affairs Office in various litigation and claim matters with unique expertise in hospital and physician professional liability matters. Independently researches and analyzes law sources such as statutes, recorded judicial decisions, district and federal court records, legal and scientific medical articles, etc. to prepare various internal legal documents. Reviews various bills to ensure compliance with litigation guidelines, etc.
Your Job Requirements:
Nursing Degree from accredited college or university required
Clinical Nursing background required
Nursing Paralegal certification preferred but not required
1-2 years of nurse paralegal experience working in a litigation practice or in healthcare environment preferred
Knowledge of legal terminology and principles preferred but not required, knowledge of medical terminology required
Proficient in Microsoft Office (including Word, Excel, PowerPoint, Outlook), Document and/or Claims Management database systems, expense/billing and contract management systems. Hospital or healthcare industry knowledge/experience is preferred.
Superior oral and written communication skills
Strong process and confidentiality orientation
Detail oriented, logical, and methodological approach to problem solving
Demonstrated capability to interface and maintain effective relationships with all departments, employees, and outside defense counsel in a team-oriented environment
Your Job Responsibilities:
Investigates facts and independently prepares documents to assist internal and external attorneys and legal office team members with claim matters, written legal discovery responses, subpoena duces tecum preparedness, etc.
Reviews medical records to evaluate care, identifies potential witnesses, and prepares a case summary on cases identified as potential claims and takes a proactive role in raising questions about reserves based upon knowledge of discovery answers and facts of case as it develops.
Organizes and indexes complex case files using primarily electronic claim filing system
Performs wide variety of legal research, data compilation, and statistical reports with little or no supervision
Prepares reports, correspondence, chronologies, case summaries of medical malpractice, general liability, and other cases for internal decision making and claims management.
Communicates with witnesses, experts, and external defense counsel in preparation for depositions, mediations, arbitrations, and trials with attendance on behalf of MHS at such when applicable.
Oversees or reviews billing and expense data from external law firms in a timely manner, communicates items that don't adhere to MHS Litigation guidelines, and enters billing info into MHS claims management system for all claims.
Determines and calendars deadlines to help manage claims, insurance carrier notifications, and facilitate claim closures.
Attends the Risk Management and Closed Claim Committee meetings and provides routine summaries of claims outcomes or issues relevant to clinical risk and quality management.
Maintains confidential quality reviews, evidence, documents, and communication on legal cases. Ensures maximum protection from discovery of all such materials.
Completes other duties as assigned by the MHS Chief Legal Officer, Associate General Counsel, or Assistant VP, Corporate Risk Management at MHS.
We know that employees who are happy, healthy, and fulfilled take better care of patients. We also know that caring for our employees as individuals makes us a better organization. Our benefits include:
Medical plan choices Pharmacy coverage Dental and vision plans AD&D insurance Employee assistance program Flexible spending account Paid time off Extended illness benefits Wellness program Weight management, tobacco cessation, and prenatal programs Basic and volunteer life insurance Short-term and long-term disability Retirement plans with matched contributions Leave of absence Tuition reimbursement Adoption assistance Employee discounts And more.
Methodist Health System is comprised of four thriving hospitals serving the southern perimeter of the Dallas and Fort Worth Metroplex. Methodist Dallas Medical Center is one of Dallas' finest and largest not-for-profit hospitals. This 515-bed major teaching and referral facility is the flagship hospital for Methodist Health System. Located just 10 minutes away, Methodist Charlton Medical Center is a modern 269-bed facility located in the suburbs of Southwest Dallas County. Opened in December of 2006, Methodist Mansfield Medical Center is a state-of-the-art 168 bed, full-service hospital located in Mansfield, TX south of Arlington and Fort Worth in Tarrant County. Methodist Richardson Medical Center, a 205-bed acute care hospital, serves residents of Richardson, Plano, North Dallas and the surrounding communities. Additionally, Methodist Family Health Centers have been established to better meet healthcare needs in the outlying communities.
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Case Management Society of America 6301 Ranch Drive Little Rock, AR 72223