04/27/2012 04250

CHIEF, DIVISION OF CLAIMS ADMINISTRATION, MCARE

DEFINITION:

This is managerial work directing the activities of the Claims Administration Division within the Bureau of Medical Care Availability and Reduction of Error Fund (MCARE) in the Pennsylvania Insurance Department.

The employee in this job is responsible for planning, directing and evaluating the investigation and resolution of medical malpractice claims in accordance with applicable Commonwealth laws and regulations. Work involves directing the review and analysis of medical malpractice liability insurance company financial reports; developing and administering training programs for eligible health care providers; and directing and assessing performance of retained defense counsel and managing the timely, reasonable and fair compensation to medical malpractice claimants. Supervision is exercised over a professional, technical and clerical staff. Work is performed with considerable independence and is reviewed by the Bureau Director for compliance through conferences, meetings and reports.

EXAMPLES OF WORK:

Develops, plans, and coordinates the investigation and resolution of medical malpractice claims.

Oversees and manages the activities of a Third Party Administrator (TPA) engaged in the administration of medical malpractice claims.

Recommends changes to procedures on the payment and settlement of medical malpractice claims.

Directs and assesses the performance of retained defense counsel litigating medical malpractice claims on behalf of the Department.

Consults with departmental staff, representatives of the medical and legal communities, the public and other stakeholders involved in medical malpractice claims.

Oversees the analysis of medical malpractice claim files of insurance providers to ensure complete investigations and the use of appropriate defense strategies to protect the Commonwealth’s financial interests.

The employee in this job may participate in the performance of subordinates' work consistent with operational or organizational requirements.

Performs the full range of supervisory duties.

Performs other related work as required.

REQUIRED KNOWLEDGES, SKILLS AND ABILITIES:

Knowledge of the methods and techniques of claims evaluation, investigation, settlement and defense.

Knowledge of insurance terminology and the regulations pertaining to contractual provisions of insurance policies and payment of claims.

Knowledge of medical malpractice insurance principles and practices.

Knowledge of the law of tort, judicial procedures, statutes of limitations, actions in assumption and trespass, and the basic rules of evidence.

Knowledge of medical terms, standards of care for injuries and illnesses, and treatment expenses.

Knowledge of legal costs of malpractice suits and appropriateness of establishing annuities and trust agreements.

Knowledge of social and economic trends affecting the medical professional liability insurance industry.

Knowledge of the delivery and financial systems for medical professional liability insurance.

Knowledge of negotiation principles and practices.

Knowledge of the principles and practices of employee supervision.

Ability to analyze and interpret claims handling procedures.

Ability to establish and maintain effective working relationships.

Ability to effectively communicate orally.

Ability to effectively communicate in writing.

MINIMUM EXPERIENCE AND TRAINING:

One year as a Medical Malpractice Claims Manager;

or

Seven years of professional experience examining medical malpractice insurance claims, which included two years of medical malpractice insurance claims program supervisory experience and a bachelor’s degree;

or

Four years of professional experience examining medical malpractice insurance claims, which included two years of medical malpractice insurance claims program supervisory experience and a Juris doctorate.