The University of Kansas Health System in Kansas City is a world-class academic medical center and destination for complex care and diagnosis. We offer more options for patients with serious conditions because of our expertise and leadership in medical research and education.
The Risk and Claims Specialist is primarily responsible for ensuring that insurance policies and certificates of insurance for The University of Kansas Health System and The University of Kansas Physicians are maintained, up to date, regularly reviewed, and compliant with laws, regulations, licensing and credentialing requirements. This position also works together with the Brokers, Insurance Providers and Health Care Stabilization Fund to coordinate insurance policy requirements. This position assists the General Counsel, UKP and UKHA Claims, Risk, and Insurance Directors to mitigate risk and manage liability claims, litigation and potentially compensable events. The specialist acts as a liaison between UKP, UKHA and outside agencies.
- Demonstrates competence in the areas of critical thinking, interpersonal relationships, computer database systems and software, and technical skills.
- Assists with the development, implementation and monitoring of the claims management program for the organization.
- Investigates events and circumstances that could lead to financial loss, coordinates activities with claimants, insurance companies and legal counsel as appropriate.
- Assists in developing and maintaining policies, procedures and protocols to support risk management, claims and insurance activities.
- Participates on various Patient Relations committees such as a Grievance and Appeal committee as a member and consultant.
- Serves as a proactive resource to departments and committees to promote safe and quality patient care and reduce liability exposure.
- Exercises professional judgment and critical thinking in facilitating prompt and compassionate claims management.
- Coordinates with the Directors the development and presentation of educational programs on risk management issues and claims trends.
- Promotes the containment of claims and losses, through early identification, assessment and resolution.
- Acts as liaison between the Board of Healing Arts and UKP physicians by serving as point of contact and negotiating submission terms for complaints.
- Assists with insurance coordination and renewal of all insurance policies for the University of Kansas Health System (TUKHS) and the University of Kansas Physicians (UKP).
- Ensures hospital, physicians and other care providers’ insurance certificates are current and in full compliance with licensing and credentialing requirements, keeping track of important policy changes and details.
- Provides Certificates of Insurance and facilitates obtaining insurance claims history verification required for credentialing of providers and affiliates. Responds to and facilitates external requests for insurance verification to credentialing agencies and the Health Care Stabilization Fund (HCSF).
- Responsible for filing the necessary reporting paperwork for insurance claims brought on behalf of UKP and UKHA.
- Provides education, support and assistance to physicians on reporting and responding to insurance claims and lawsuits.
- Assists and participates with the Directors of Claims, Insurance and Risk Management, in early communication and resolution protocol in response to unanticipated negative outcomes of care.
- Works effectively with TUKHS Compliance, Risk Management, and other departments to provide information related to claims and insurance.
- Participates in education and orientation of new physicians as requested.
- Collaborates with insurers and defense counsel in the efficient management of claims including resolution when appropriate.
- Supports UKP and TUKHS risk and claims management activities as requested.
High School Diploma
3+ years of experience handling insurance matters in a law office, or risk, insurance, and claims management in a healthcare environment
- Bachelor’s Degree in healthcare-related field
- Paralegal certificate
- Legal assistant
- ARM, AIC, AINS, CPCU, or RPLU a plus
- Medical records knowledge
- Clinical background and training