Director of Claims and Litigation

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Department Name: Banner Staffing Services-AZ Work Shift: Varied Job Category: Legal Banner Staffing Services (BSS) also offers Registry/Per Diem opportunities within Banner Health. Registry/Per Diem positions are utilized as needed within our facilities. These positions are great way to start your career with Banner Health. As a BSS team member, you are eligible to apply (at any time) as an internal applicant to any regular opportunities within Banner Health. In this role you will manage claims and litigation case information and filings and will work alongside the defense counsel. Flexible hours & scheduling. This role is mostly remote with some onsite/travel requirements. Will consider candidates in the following locations who are willing to travel to Arizona and Colorado periodically: Arizona, California, Colorado, Idaho, Iowa, Kansas, Nebraska, Nevada, New Mexico, Missouri, Oklahoma, Oregon, Texas, Utah, Wyoming, Washington As a valued and respected Banner Health team member, you will enjoy: Competitive wages Paid orientation Flexible Schedules (select positions) Fewer Shifts Cancelled Weekly pay 403(b) Pre-tax retirement Employee Assistance Program Employee wellness program Discount Entertainment tickets Restaurant/Shopping discounts Auto Purchase Plan BSS Registry positions do not have guaranteed hours and no medical benefits package is offered . BSS requires Completion of post-offer Occupational Health physical assessment, drug screen and background check (includes; employment, criminal and education). POSITION SUMMARY This position is responsible for strategizing and implementing a cost effective and successful process to manage Hospital and Physician Professional Liability (HPPL), General Liability (GL) and Employment Practices Liability (EPL) claims and litigation and co-manages other insured and uninsured litigation across the Banner Health (BH) system upon request. Designs and directs the claims investigation process; evaluates each claim with respect to liability (standard of care -SOC), causation and damages; develops a resolution strategy and fairly and equitably resolves claims and lawsuits. CORE FUNCTIONS 1. Knows, understands, incorporates and demonstrates the mission, vision, values, brand, strategic initiatives, core measures and core behaviors into leadership behaviors, practices and decisions. Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of BH with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day. 2. Formulates and implements a thorough investigation plan for each claim. Evaluates each claim with respect to standard of care, liability, causation, and damages. Determines whether a preservation hold has been or needs to be issued. Considers witness credibility and consultants/expert opinions and determines the value of the claim. Determines and sets appropriate indemnity and expense reserves in a timely manner and periodically re-evaluates such reserves. Maintains a diary system to monitor all open claims. Updates claim files per documentation guidelines. Apprises Director of Claims and VP Business Health of case developments as appropriate. Obtains settlement authority as established by policy. Within delegated authority limits, independently negotiates or directs the negotiation of the claims/lawsuits to resolution. Represents facility, physician, and or BH at case evaluations, pre-mediation meetings with families and mediators, mediations and trial. Notifies reinsurer of selected claims according to established criteria and provides file updates pursuant to reporting guidelines. 3. Responsible for obtaining, entering data into claim file and monitoring such data in order to comply with deadlines for meeting Medicare, Medicaid, Ship Extension Act (MMSEA) reporting requirements in relation to claimants and others releasing medicals. Responsible for determining amounts of liens, rights of recovery and rights of reimbursement with regard to Medicare Secondary Payer Act, other state, federal, and private third party payers and adheres to all state and federal laws, rules and regulations. 4. Participates in the attorney selection and re-evaluation process with the Director of Claims and VP Business Health. Retains approved defense counsel on a per claim basis after checking conflicts. Directs and supervises the work of outside defense counsel pursuant to litigation protocol. Reviews and responds to attorney inquiries, reports and recommendations as appropriate. Reviews and approves the defense counsel fees and litigation expenses. In conjunction with defense counsel establishes a claim resolution strategy, facilitates and communicates same. Provides guidance and clarity to other team members relating to litigated matters. 5. Presents comprehensive information at internal

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