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CLAIMS INVESTIGATOR

Methodist Health System - Dallas, TX
Full-time 8:30-5 Day
Your Job Purpose:
Assists in the investigation and management of risk-related events on behalf of various quality assurance and medical peer review committees and the Legal Affairs Department, as applicable. Supports the mission, vision, values and strategic goals of Methodist Health System.
Your Job Requirements:


Associate of Science in Nursing, Bachelor of Science Nursing

Nursing or clinical background required
Your Job Responsibilities:


Attends the Risk Management Committee meeting. ?

Completes other duties as assigned by the Chief Legal Officer, Associate Attorney, or Administrator of Risk Management at MHD (assist with maintaining STARS claims management software)

Maintains MHD computerized claims history on STARS software program. Develops and produces reports for the Legal Affairs Department on a wide variety of matters. -

Reports and maintains all potential/actual claims in a timely fashion within established guidelines. Maintains confidential evidence, documents, and communication on legal cases. Ensures maximum protection from discovery of all such materials. Maintains the ongoing risk reporting process with the Quality Assurance, Patient Complaint, and Medical Records Departments as well as in each high risk department/specialty.

Reviews medical records to evaluate care, identifies potential witnesses, and prepares a case summary on cases identified as potential claims and takes a proactive role in raising questions about reserves based upon knowledge of discovery answers and facts of case as it develops.

Works with outside counsel to coordinate information gathering and answering of interrogatories and requests for production, including gathering policies and procedures and other written documents. Works with outside counsel to prepare key witnesses for depositions and trials.

Works with Quality Assurance personnel to obtain their assessment of cases, as applicable. Interviews witnesses and investigates events on an as needed basis in all hospitals.