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Professional Liability Investigator

Department: Claim
Location: New York, NY
Company: HRA

This position is the primary investigator of occurrences at the institutions insured through HRA’s Insurance Program. In addition, this position also participates in committee meetings, risk management programs and claim review activities. The Professional Liability Investigator assists in the defense of medical malpractice lawsuits and claim management and identifies issues that may have an impact on the quality of care at insured institutions. .

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ESSENTIAL DUTIES & RESPONSIBILITIES:

  1. Investigates letters of claim and potential high exposure alerts; reviews and summarizes medical records, interviews involved parties and generates investigation reports that cover all key issues and / or allegations.
  1. Completes summons reviews on all hospital-based lawsuits; reviews pleadings, conducts focused reviews of medical records, and identifies potential witnesses (including their roles and contact information) involved in the plaintiff’s treatment in question.
  1. Reviews and integrates relevant information from the legal file and documents into the investigation process.
  1. Prepares, types, and submits investigation reports to the Investigative Coordinator for finalization and distribution according to department protocol.
  1. Provides information on occurrences, issues, and findings to Manager, Professional Liability Investigations and hospital Risk Managers.
  1. Accurately documents investigative findings in eOASIS claim system. Updates appropriate fields in eOASIS following investigation, including the risk management database.
  1. Following investigation of a case, ensures the Investigative Associate (IA) has appropriately requested the security of evidence.
  1. Reviews medical records for liability and authorize, on behalf of the client, their release as requested by attorneys or patients, as necessary.
  1. When the IA is not available, opens unasserted cases (alerts and ARLs) on the eOASIS claim system and requests security of appropriate documents and items relevant to the defense of cases according to specified procedures.
  1. Provides guidance to IAs regarding investigation requests.
  1. Uploads all medical records of assigned asserted cases into OnBase.
  1. Reviews defense attorney correspondence as necessary; responds to defense counsel or the claim examiner/ attorney investigation requests for hospital records and/or policies, obtains/provides relevant medical evidence when the IA is not available, and conducts relevant interviews upon request by defense counsel or claim examiner. 
  1. Participates in PLI orientation program, as requested.
  1. Performs other duties and special projects as required or as assigned.

PERFORMANCE METRICS:

  1. Investigates at least 10 cases per quarter.
  2. Finalizes investigation reports within 4 to 6 weeks of dictation/submission, and updates eOASIS within 7 days following investigation report finalization. Completes summons reviews within 30 days of assignment.
  3. Achieves a Quality Assurance rating of at least 3 on investigation reports.
  4. In the absence of the IA, the PLI opens unasserted cases, completes applicable fields and requests security of relevant evidence within 30 days of assignment.

QUALIFICATIONS AND REQUIREMENTS:

Education/Certification

  • AA/BA/BS degree. RN, PA, or healthcare related license required.          

Experience Required

  • 3-5 years of clinical experience.

Skills/Abilities:

  • Demonstrated knowledge of medicine required.
  • Excellent interpersonal and communication skills.
  • Strong writing skills.
  • Good organizational and project management skills.
  • Able to work under pressure and meet deadlines.
  • Basic Microsoft Office Suite skills.
  • Ability to work independently and be flexible.
  • Ability to multi-task. 
  • Ability to travel within the tri-state area.

POSITION CLASSIFICATIONS:

Classification: Non - Union

FLSA Status: Exempt  

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The statements herein are intended to describe the general nature and level of work being performed by employees and are not to be construed as an exhaustive list of responsibilities, duties, and skills required of personnel so classified.  Furthermore, they do not establish a contract for employment and are subject to change at the sole discretion of HRA.  All employment with HRA is of an at-will nature.  HRA is an equal opportunity employer and complies with applicable worker and workplace employment laws and regulations.

 

 

 

 

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