Jan 10, 2019

Legal Claims Specialist

  • Sutter Health
  • Sacramento, CA
Full time Health Care

Job Description

**Description** The Legal Claims Specialist is responsible for analyzing and processing reported affiliate events that are associated with potential or pending liability for SISCO and Sutter Health. This position maintains the claims database of high risk events, litigation, claims, trial preparation and progression, and other related risk and legal documents and correspondence. Through analysis of the CEIF and other legal correspondence, the Legal Claims Specialist determines whether Consultant action is indicated for a pending claim or litigation. This comprehensive review will result in appropriate communication with the assigned Consultant or HCR Director for further action. Producing reports and analysis of specific reports for department leadership and affiliate risk managers plays a role in the overall reduction of risk and liability for both SISCO and Sutter Health. **Qualifications** **Education:** High school diploma or equivalent is required in addition to an education, background or experience in the healthcare, insurance or the legal field. **Experience:** Experience that has fostered the development of advanced analytical, technical and communication skills within a healthcare setting, insurance company or a law firm is required. Prior experience in risk management, legal and medical terminology and processes, claims management or related fields is required. The ability to demonstrate computer experience in organizing and managing a code-driven software operation is required. Prior experience in specialty computerized medical and legal information systems is preferred. **Knowledge:** Possess analytical skills and knowledge to identify and evaluate distinctions between legal documents and other claims related information. Possess ability to evaluate relevant information and individual judgment in order to determine compliance with departmental policies or standards. A working knowledge and understanding of healthcare organizations, functions, and policies and procedures is preferred. Practical knowledge of healthcare risk management processes, claims management, and civil legal process is required. Excellent communication skills, both verbal and written are required as well as excellent knowledge of the English language, including correct use of spelling, grammar and punctuation. **Special Skills/Equipment:** Must be detailed oriented, flexible, self-directed and be able to work with highly confidential information that is extremely time sensitive. Must have the ability to effectively utilize problem solving skills, investigate sensitive issues, and maintain excellent professional relationships within the department and at all levels of the organization. Strong problem solving skills and ability to work independently and reprioritize workload with minimal supervision is required. The ability to communicate verbally and in writing in a clear and concise and professional manner is essential. Proficient computer skills, including knowledge of word processing, email, and use of the internet is necessary. Typing speed of 65 wpm is required. **Primary Location:** California, Greater Sacramento Area, Sacramento **Organization:** Sutter Health System Office **Employee Status:** Regular **Benefits:** Yes **Position Status:** Non-Exempt **Union:** No **Job Shift:** Day **Shift Hours:** 8 Hour Shift **Days of the Week Scheduled:** Monday-Friday **Weekend Requirements:** None **Schedule:** Full Time **Hrs Per 2wk Pay Period:** 80 All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.

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