Director, Claims and Finance - Risk Management – Full Time 8 Hour Days (Exempt) (Non-Union) Job Listing at Keck Medicine of USC in Los Angeles, CA (Job ID 75977036880)

Description

The Integrated Office of Risk Management is responsible for developing and implementing Enterprise Risk Management systemwide, identifying and developing strategies to minimize the impact of risk, developing a center of excellence for managing risk, Risk Financing and Claims Oversite, reducing costs and improving safety by executing new ideas and strategic plans in a rapid manner. By strategically Integrating the Risk Management, Claims, and Finance disciplines we can reduce the chances of loss, create greater financial stability, and protect our resources in support of Keck's mission. To provide leadership, policy direction and Assist the Executive Administrator in oversight of the Hospitals insurance programs for Professional Medical & Hospital Liability and other insurance programs as identified. In addition to management of the above programs, this position supports and maintains a risk-aware culture systemwide, formally bringing consideration of risks into strategic decision making for the involved programs. This involves, but is not limited to, selection and oversight of the claims management, risk financing, insurance coverage issues, loss prevention and regulatory compliance issues related to the above programs. The position reviews fees for outside defense attorneys, oversees the legal billing compliance vendor, and works closely with defense counsel, Office of General Counsel, medical center risk managers and the Claims on strategic decisions on HPL cases. The position has the authority and responsibility to review claims and lawsuits and recommend approval for expenses and settlements subject to the authority levels set. The position collaborates closely with the Hospital captive/Captive/Insurers in financing and other decisions.

Essential Duties:

• Operations and Management: Manages the activities of the claim administrator or Insurance Program. Recommend funding strategies and funding levels for insurance programs; retain independent actuaries to develop annual funding (premium) requirements for the campuses, and medical centers; develop premium allocation methodologies to equitably distribute the costs of the self-insured programs and provide incentives for loss control. Oversee the documentation and reporting of claims Review performance and perform claims audits to ensure a high quality of claims administration and a high level of service to the medical centers. Provide guidance to medical center Risk Managers, School of Medicine Clinical Chairs and Deans, Chief Executive Officers, Chief Medical Officers, and Office of General Counsel; take the lead in solving problems and resolving issues arising from healthcare Center Concerns. Oversee systemwide incident reporting and feedback for PEARL and DARTS Programs. Collect and analyze information and data required for the insurance underwriting process; participate in negotiations with insurers and develop and present information to insurers on University claims and exposures Communicate with and advise underwriters' representatives, broker on high exposure cases. Manage Broker in the collection of full -time equivalent exposure data for premium collection purposes. Provide in collaboration with broker information and consultation to campuses on insurance and coverage questions. Responsible for guidelines to Support board governance of insurance claims program.
• Risk Claims Administration: Oversee and review/provide information to Hospital independent actuary regarding program performance for actuary reports. Provide authority outlined in Claims process to proceed to settlement negotiations in all PEARL cases. Provide input and approval to decisions on reporting to California Medical Board and/or National Practitioner Databank. Provide input and guidance on case development and strategy (early investigation), particularly on high exposure cases. Negotiate and administer budgets for claims administration services; evaluate self-insured program claims expenses to maximize efficiencies and control/reduce claim and program costs while vigorously advocating on appropriate cases. Provide coverage analysis and support for human subject research claims. Assure continued robust reporting of Precautionary Incident Notifications (PINs). Review Performance of outside defense counsel. Participate in mediation on appropriate cases.
• Process Improvements/ Quality: Identify and pursue opportunities for recoupment of costs from third parties. Collaborate on programs and practices designed to prevent and/or reduce losses with medical center risk management staff; provide advice, and training to medical center risk management staff at the various locations. Propose and Manage program's premium rebate program for BETA Heart or Similar if Self Insured, which funds individual grants to each location to reduce risk. Identify, develop and implement processes to improve handling, defense and/or resolution of claims in an efficient, cost effective manner, including Decision Analysis Reserve and Trial Strategy Process. Develop policy and procedures and implement program guidelines for all lines of coverage Interface with Insurance and Office of General Counsel to identify, develop and implement improvements to the program. Maintain awareness of current, relevant California law applicable to program needs and the landscape of professional liability
• Performs other duties as assigned.

Required Qualifications:

• Req Bachelor's degree Bachelor's degree in related area and / or equivalent experience / training
• equivalent experience / training

• Req 10 years 10 years of Quality/Risk Management experience, with a broad and current knowledge in tort law, insurance coverage, claims administration and claims adjusting practices.

• Req Expert and specialized knowledge in the following areas: risk management; insurance; forecasting and analysis; accounting; risk modeling process; knowledge of common organization-specific computer application programs; knowledge of organizational processes and procedures; understanding of organizational rules and regulations.
• Req Expert interpersonal skills, customer service orientation, active listening skills and highly effective team leadership skills.

Preferred Qualifications:

• Pref Master's degree Master's Degree or Advanced degree preferred

• Pref Advanced human resource management expertise to lead and direct subordinate managers and staff, including advanced skills in comprehensive personnel administration.
• Pref Strong ability to multi-task
• Pref Advanced skills to appropriately and efficiently respond to and direct the response to emergencies and critical situations, including follow-up evaluation and critique of response efficacy; skills to create, develop and implement changes to emergency situations as required.
• Pref Advanced skills in managing highly complex budgets.
• Pref Highly developed ability to concisely present complex risk findings and make recommendations verbally and in writing.

Required Licenses/Certifications:

• Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

The annual base salary range for this position is $133,120.00 - $219,648.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

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