Job Description

Under general supervision of the Associate General Counsel; Director of Dispute Resolution, specializes in investigating and assessing information related to complex claims against hospitals, health care clients and indemnified physicians, involving highly technical cases such as medical malpractice or product liability.  Coordinates management of claims and assists in supervision of claims administrators through closure with external legal counsel, various other insurers and excess insurance carriers.  Interviews principals (e.g. claimants, witnesses, physicians, employees), assesses pertinent data, initiates involvement of appropriate legal and/or insurance services, evaluates their performance and provides support through claim process.  Assists with quality improvement efforts identified through claims. 

PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:

• Evaluates and analyzes incidents in a timely fashion that have been identified as potential claims.  Determines strengths and weaknesses to decide what strategies can be implemented to avoid litigation and what issues must be analyzed to determine potential financial exposure.  Advises with respect to sensitive medical-legal issues.  Acts as a resource to other claims administrator (if applicable) to evaluate and plan litigation and assist in claim settlement negotiations.
• Provides for or conducts interview of key witnesses and key individuals involved in potential or actual medical malpractice cases, general liability cases and workers’ compensation cases.  Obtains expert opinion when necessary.
• Negotiates, within Associate General Counsel’s consultation and agreement, claim settlements directly with claimants or their legal representatives/attorneys.  Attempts to resolve problems without litigation.  Works with attorneys, third party administrators and related insurance companies through the claim process.
• Prepares documentation for files and disseminates relevant information to appropriate parties.  Maintains current claim information in claims management system and prepares progress notes.  Monitors claim files to ensure timely documentation and completeness.  Reviews progress notes of other claims administrators when case reserves exceed a threshold established by Associate General Counsel.  Assists in development of action plans.
• Participates in the development of case reserves and recommends changes when required.  Assists in development of answers to interrogatories and other similar legal filings.
•  Reviews confidential material contained in medical records and personnel files, abstracting pertinent information and summarizing statistically or in narrative form for review an analysis by Associate General Counsel or at request of legal counsel.
• Identifies and pursues opportunities to reduce exposure to loss in support of the system’s total quality management process.
• Maintains advanced knowledge and awareness of current practices, techniques, trends, law and precedents regarding medical malpractice or product liability by participating in ongoing, independent study, education-related professional activities and affiliations.
• Provides effective direction, guidance, and leadership over the staff for effective teamwork and motivation.
•  Maintains collaborative team relationships with peers and colleagues in order to effectively contribute to the working group’s achievement of goals, and to help foster a positive work environment.
• Performs other similar and related duties as required or directed.

Qualifications

JOB KNOWLEDGE AND SKILLS:

• Leadership – ability to provide positive leadership throughout the Wellforce community.
• Critical Thinking/ Problem Solving – ability to listen, analyze, and gather relevant information, and to use knowledge to effectively solve problems.
• Presentation Skills – ability to present information in an understandable manner in formal and informal settings.
• Analytical/Logical Reasoning – ability to use inductive and deductive reasoning to draw inferences and reach conclusions.
• Written Communication – ability to draft clear, concise, and well-structured reports, findings, and responses for internal and external stakeholders and regulatory agencies. 
• Oral Communication – ability to convey information in clear, concise, and logical terms.
• Professionalism – ability to represent Wellforce and the member organizations in a manner, which reflects the goals and principles of each, while treating all individuals with respect.
• Effective Negotiation – ability to achieve win-win solutions to problems.
• Concern for Safety – responsibility for recognizing safety issues and for appropriate follow-through.
• Personal Effectiveness – ability to set and accomplish individual goals and to assist others with achieving corporate goals.
• Prioritizing and Multitasking – ability to prioritize and multi-task on-going case load of grievances and other project assignments.
• Technology Skills – ability to master a variety of word processing, presentation, and healthcare-related software applications.
• Confidentiality – ability to maintain strict confidentiality of protected health information in compliance with internal policies and state and federal law.

In addition to the ability to perform the tasks described above, you will need to possess the following required education and experience OR a combination of education, training, or experience which provides an equivalent background required to perform this job.

EDUCATION:

• Bachelor’s Degree required.  Juris Doctor or clinical degree preferred.

EXPERIENCE:

• Three (3) years of professional experience, preferably legal or clinical experience, with major work assignments emphasizing claims management and resolution.

WORKING CONDITIONS/PHYSICAL DEMANDS:

• _ _Normal Office Setting.  No exposure to environmental hazards.

Additional Information

All your information will be kept confidential according to EEO guidelines.

AMERICANS WITH DISABILITIES STATEMENT:

Must be able to perform all essential functions of this position with reasonable accommodation if disabled.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Tufts Medical Center reserves the right to modify position duties at any time, to reflect process improvements and business necessity.

COVID-19 POLICY:

Please note that effective October 1, 2021, as a condition of employment at Tufts Medical Center, all employees and new hires must have received their complete dose of the COVID-19 vaccine, unless they have been granted an exemption.