The Senior Quality Analyst performs all duties in a manner that promotes Providence’s Mission, values, and philosophy. In all aspects, they serve as a role model for the values and Mission of the organization.

Essential Functions:

• Ensure compliance with applicable laws, insurance regulations, settlement reporting, and other regulatory reporting requirements governing liability claims handling
• Develop and provide training, job aides and technical support for caregivers regarding Centers for Medicare and Medicaid Services (CMS) Medicare Secondary Payer reporting, applicable laws, insurance regulations, and other regulations relating to investigating, evaluating, and resolving liability claims. Provide empirically-based input as to training topics
• Act as a resource to fellow caregivers for Medicare Secondary Payer reporting of third-party claim payments and write-offs and serve as our mandatory reporting authorized representative
• Facilitate monthly claims files internal audits including monthly trending analysis reporting from platform analytics, compare as to organizational metrics, and propose opportunity solutions and success replication. Propose monthly audit focus topics to claims leaders based on trending analysis. Review claim files from a quality assurance perspective to ensure compliance with applicable laws, insurance codes, regulations, and our department’s policies and procedures
• Secure monthly claims data reports and provide quality assurance recommendations to claims leaders for both indicated opportunity areas relative to organizational metrics and KPIs, compliance, best practices as well as broader application potential of high-performance indicators
• Identify and provide feedback to department leaders for claims management improvement opportunities and claims-related trends through audit, data analytics, and training observations
• Recommend improvement opportunities relating to workflow efficiencies and operationalization to department leaders
• Act as a resource and to fellow caregivers regarding applicable federal, state, and local laws, insurance codes, and regulations relating to liability claims handling, including healthcare professional and general liability matters
• Assist department leaders in developing policies and procedures, as requested
• Manage payor contracting requests for claims histories
• Perform claims-related research
• Ensure appropriate reporting of claims to excess liability insurers

Investigate, evaluate, and manage professional, general, and other liability claims under the PSJH Insurance Program:

• Communicate with patients, claimants, caregivers, providers, leadership
• Review and analyze medical records, interview witnesses, assist with the discovery process and communicate with facility risk manager regarding evaluation and investigation
• Be responsible for writing insurance policy coverage letters
• Analyze insurance policy documents to address coverage
• Set appropriate indemnity and expense reserves
• Select appropriate medical experts for case review
• Develop a plan of action for assigned claims and update the claims file following all material changes in status
• Review and approve statements for services and take proper steps to pay vendors
• Inform Senior Manager Operations of large or complex claims and claims with potential for media exposure
• Report claims with potential excess exposure to excess insurers
• Ensure compliance with relevant claims reporting procedures and required regulations
• Work with defense attorneys specializing in defense of medical negligence claims
• Have direct responsibility to foster teamwork, operational excellence, and effective communication within the claims team, including other Claims Managers, Claims Reps and Claims Specialists

Reporting to the Vice President, Treasurer this position is responsible for leading the corporate insurance program for the company and its subsidiaries worldwide. Key responsibilities include:

• Establishing operating policies and overseeing the planning, management, and execution of corporate insurance strategies.
• Providing leadership on risk and insurance issues to ensure cost-effective insurance programs.
• Minimizing the financial impact of accidental losses by:
• Identifying, eliminating, and controlling potential risks.
• Managing claims handling and funding strategies.
• Utilizing funding vehicles such as self-insurance, captive insurance, and traditional insurance products.
• Collaborating with key stakeholders, including senior management, legal teams, safety teams, and business leaders, to align insurance strategies with company objectives.
• Supporting the assertion of claims against the company’s legacy insurance carriers for long-tail claims.
• Ensure corporate risk management strategy aligns with overall financial goals.

This position is responsible for contributing to the growth, return expectation, and overall objectives of the company and its subsidiaries by actively managing the financial planning and analysis activities. The position will interact regularly with Senior Leadership and will construct financial models for major projects that drive the future direction of the business. Prospective candidates for the position must possess very strong financial and analytical skills along with an entrepreneurial mindset and the ability to collaborate well with others.