Career Center

Department Overview

OHSU is Oregon's only public academic health center. We are a system of hospitals and clinics across Oregon and southwest Washington. We are an institution of higher learning, with schools of medicine, nursing, pharmacy, dentistry and public health - and with a network of campuses and partners throughout Oregon. We are a national research hub, with thousands of scientists developing lifesaving therapies and deeper understanding. We are a statewide economic engine and Portland's largest employer. And as a public organization, we provide services for the most vulnerable Oregonians, and outreach to improve health in communities across the state.

Under the direction of the Vice President of Risk Management or designee, this position is responsible for processing and adjusting claims and litigation related to hospital professional liability (HPL) and other lines of coverage as appropriate. In addition, under the direction of the Vice President of Risk Management or designee, this position provides loss prevention education and training, risk mitigation advice, and investigation and analysis of the frequency, severity, and causes of adverse events. These responsibilities are performed with the objectives of minimizing losses to the assets of the entire OHSU system from patient-safety-related events and analyzing adverse events to identify patient safety improvement strategies.

Function/Duties of Position

*This is a Hybrid position. Candidate will need to be available to work in Portland as needed.*

• Maintain assigned claim files, which includes the following components:
  • Identify type and status of claim.
  • Prepare claim file setup.
  • Conduct detailed investigation.
  • Select and monitor defense counsel, if needed.
  • Review claims for purposes of evaluating coverage, liability, damages, and claims/litigation management strategy.
  • Monitor ongoing medical treatment or patient's recovery.
  • Establish and apply value/quality standards to assess the performance of and supervise third party vendors (defense counsel, consultants, etc.) in the event they are engaged for purposes of individual claims.
  • Maintain claims performance standards to assure timely response to and resolution of claims, and timely documentation of claims activities.
  • Negotiate timely and appropriate settlements with claimants, insureds, employees, attorneys and insurance companies within authority.
  • Ensure compliance with Medicare/Medicaid guidelines as related to claims.
  • Report to regulatory agencies as required.
  • Report potential claims, claims, and lawsuits meeting reporting criteria as established by insurance policy to excess carrier representatives.
  • Attend provider meetings, expert meetings, depositions, mediations, arbitrations, trials and other court room proceedings as necessary.
  • Present cases to review committees.
  • Review, approve and process claims-related legal fees and expenses, and claims-related indemnity payments.
  • Explain OHSU policies, claims processed and procedures to OHSU staff, external counsel and insurers.
  • Maintain ongoing communications with all claimants, insureds, defense counsel, and insurance carriers.
  • Make decisions and judgments regarding claim/litigation strategy, including identifying matters suitable for early resolution.
  • Identify, initiate and manage opportunities for subrogation, reimbursement and recovery of claim payments as appropriate.
• Respond to individual risk management and quality assurance questions from OHSU employees. Serve on assigned committees, task force or work groups, and other interdepartmental efforts to consult on quality assurance and patient safety measures and opportunities for improvement. Identify patient safety improvement strategies and consult on the design of new quality assurance elements and systems, which includes the following components: Track, analyze and report on claims data to assist with identification of frequency, severity and causes of adverse events and share reports with peer review and quality assurance bodies for use in patient safety efforts. Create and present loss prevention training and education at the request of healthcare leadership for faculty, residents and students.
• Maintain positive, professional relationships with all internal and external customers. Keep abreast of current customer needs and current industry trends. Meet established goals, demonstrate dependability, promote positive customer service, and demonstrate teamwork/management control, judgment, decisiveness and technical ability in performance of all assigned tasks
• Other tasks as assigned.

Required Qualifications

• JD and 3 years of professional experience in professional liability or claim management of medical malpractice litigation, or an equivalent combination of training and experience, preferably with a combination of experience related to claims management and work in the healthcare field.
• Equivalent combination of training and experience that will be accept is as follows:
  • Individuals with a relevant Associates will require 8 years of related experience;
  • those with relevant Bachelor's degree will require 6 years of related experience AND
  • those with a relevant Master's degree will require 5 years of related experience.
• Proficient in using Microsoft Office products and database tools.

Job Related Knowledge, Skills and Abilities (Competencies):

• Familiarity with medical and insurance terminology.
• Correct language usage, grammar, spelling, punctuation and vocabulary.
• Ability to exercise good judgement, tact and sensitivity.
• Review and address large number of claim documents and forms under time constraints.
• Demonstrate organizational and analytical skills.
• Compile and prepare reports and correspondence.
• Operate standard office equipment including computers and related software applications. Plan and organize work, meet schedules and timelines, maintain records; Read, interpret, apply and explain rules, policies, procedures and regulations.
• Ability to resolve internal and external customer complaints and concerns.
• Ability to communicate clearly and effectively, both verbally and in writing

Preferred Qualifications

Registrations, Certifications, and/or Licenses:

• Oregon Bar, Paralegal Associate Degree or Certificate, RN, CPHRM, ARM, Washington Bar

Additional Details

• Variable work hours, call coverage, possibly some patient contact.
• Telecommute may be available.

$89,793.60 - $143,416.00 annually (Commensurate with qualifications, experience and internal equity)

#LI-EC1

All are welcome