Position Classification Description

Position Class Code / Title: C0009 / Med Malpractice Claims Splst
Recruitment Tier: Tier 1
FLSA: Exempt
Grade: 13

This is a description of a Staff Position Classification. It is not an announcement of a position opening. To view descriptions of current openings, please go to UNMJobs and Search Postings to view positions that are currently accepting applications.

The following statements are intended to describe, in broad terms, the general functions and responsibility levels characteristic of positions assigned to this classification. They should not be viewed as an exhaustive list of the specific duties and prerequisites applicable to individual positions that have been so classified.

Summary

Within the Office of the University Counsel, investigates and evaluates complex and severe claims, primarily related to medical malpractice. Participates in all aspects of a claim file, under the direction of a claims attorney, including data gathering, investigation, and development of claim summaries and timelines. Prepares and maintains appropriate documentation in applicable databases and information systems. Prepares claim reports and communicates updated claims information to health system entities, as directed.

Duties and Responsibilities

  1. Assists with and/or directly handles all aspects of a claim file from beginning to conclusion, including the investigation, determination of liability, confirmation of coverage, assessment of damages, and drafting of claim evaluation for recommended action.
  2. Investigates claims, obtains appropriate data, and assembles appropriate medical information and facts regarding claims, including evaluation of clinical charts, interviewing healthcare providers, securing internal reviews, and developing case summaries and timelines.
  3. Utilizes litigation management and claims management information systems to maintain, organize, and retain relevant claims data and files.
  4. Reviews all claims for status of investigation, assessment of liability, documentation of damages, adequacy of reserves, evaluation of expert witnesses, documentation of recent developments and current plan for claim resolution.
  5. Manages relationships and provides support for internal and external customers, serving as a primary source of contact and support for individuals named and/or involved in claims and lawsuits.
  6. Maintains cooperative working relationships with other departments and entities in order to facilitate quick responses to internal and external customers.
  7. Participates in problem solving and problem resolution, in accordance with University policy, state and federal guidelines and statutes, and regulatory agency requirements.
  8. Identifies trends and opportunities in medical malpractice claims and participates in reporting and communication, as directed.
  9. May assist with efforts to educate campus constituents regarding risk issues identified through claims data in order to mitigate future liabilities; may assist in the response to discovery requests.
  10. Performs miscellaneous job-related duties as assigned.

Minimum Job Requirements

  • Bachelor's degree; at least 4 years of experience that is directly related to the duties and responsibilities specified OR medical licensure (Registered Nurse, Physical Therapist, Occupational Therapist, Physician?s Assistant or similar); at least 2 years of experience that is directly related to the duties and responsibilities specified.
  • Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.

Knowledge, Skills and Abilities Required

  • Strong investigative and problem resolution skills.
  • Strong interpersonal skills and the ability to work effectively with a wide range of constituencies in a diverse community.
  • Knowledge of medical and legal terminology.
  • Ability to use independent judgment and to manage and impart confidential information.
  • Ability to develop and maintain recordkeeping systems and procedures.
  • Knowledge of the judicial system and procedures.
  • Ability to analyze, interpret and draw inferences from research findings, and prepare reports.
  • Knowledge of principles, procedures, and standards for drafting a range of complex legal documentation in area of expertise.
  • Knowledge of current and emerging developments and trends within area of expertise.
  • Advanced working knowledge of legal research principles, methods, techniques, and resources.
  • Interviewing and data collection skills.
  • Ability to work independently and as a member of a team.
  • Ability to gather and organize legal evidence.
  • Ability to communicate and interact effectively with practicing physicians and clinical management.
  • Ability to accurately communicate and record medical, forensic, and legal information received over the telephone and/or in written reports.
  • Proficiency in the use of computers and Microsoft Office software.

Conditions of Employment

  • Must be employment eligible as verified by the U.S. Dept. of Health and Human Services Office of Inspector General (OIG) and the Government Services Administration (GSA).
  • Employees who provide services or work in patient care or clinical areas are required to be in compliance with the University's influenza vaccination requirement.

Working Conditions and Physical Effort

  • No or very limited exposure to physical risk.
  • No or very limited physical effort required.
  • Must obtain NM CID Electrical Specialty (ES3J) Journeyman's license within 12 months of date of hire.

The University of New Mexico provides all training required by OSHA to ensure employee safety.

Revised Date: