Director-Risk Management & Claims

Overview

Purpose of Position and Scope of Responsibility:

Provides leadership oversight for Baptist Memorial Health Care Corporation’s system-wide claims program, including professional liability and general liability matters, working in close coordination with the Senior Associate General Counsel – Claims Oversight and General Health Law or designee. Responsibilities include but are not limited to providing operational oversight for claims administration for assigned areas of responsibilities across the Baptist system, including claim intake, investigation, documentation, reporting, reserve review, litigation support, settlement coordination, vendor performance, and related activities. Works in partnership with the Legal Services team, Risk Management, Safety, Finance, entity leadership, clinical and operational leaders, third-party administrators, insurers, brokers, and outside counsel to support consistent, cost-effective, and defensible claim management. Serves as a system-level liaison and promotes a culture of respect in alignment with Baptist’s Mission, Vision, Values, and CARES Principles.

Essential Functions

• Manages the daily operations of the claims function for professional liability and general liability claims across designated Baptist markets, to include hospital entities, affiliates, employed provider settings, ambulatory locations, and other applicable sites of care or business operations.
• Coordinates timely claim intake, assignment, documentation, investigation, and follow-up to support accurate claim evaluation, regulatory compliance, and appropriate resolution.
• Partners with legal counsel, risk management, operational leaders, clinical leaders, human resources, employee health, and safety personnel to gather information, evaluate exposure, and support effective claim strategy.
• Serves as an operational contact for third-party administrators, insurers, brokers, outside counsel, adjusters, and other vendors involved in claims administration and litigation management for areas of responsibility.
• Monitors claim activity, reserves, expenses, litigation status, settlement recommendations, recovery opportunities, and closure plans to support effective financial stewardship and risk mitigation.
• Maintains accurate claim files, databases, dashboards, correspondence, and reports to support timely communication, audit readiness, insurance program administration, and leadership decision-making.
• Uses claims analytics and trend data to evaluate claim frequency, severity, cost, status, and emerging patterns; identifies actionable insights, communicates key findings to appropriate stakeholders, and supports data-informed recommendations for operational improvement and risk reduction in conjunction with Risk Management.
• Assists with insurance renewals, actuarial reviews, reserve analyses, self-insured retention monitoring, captive or excess coverage reporting, and other insurance program activities as requested.
• Promotes consistent claims processes across the health care system and supports the development, review, and implementation of policies, procedures, workflows, templates, and training materials related to claims management.
• Ensures confidentiality and appropriate handling of privileged, protected, personnel, medical, and sensitive claim information in accordance with applicable laws, policies, and organizational expectations.
• May supervise or provide direction to claims coordinators, analysts, administrative staff, or other team members, including workflow assignment, coaching, performance feedback, and process standardization.
• Performs other duties as assigned or directed.
  
  

Qualifications And Experience

• A Bachelor’s or Associate’s degree in business, health care administration, risk management, human resources, insurance, legal studies, or a related field is required.
• Minimum of five years of progressively responsible experience with a bachelor’s degree, or eight years of progressively responsible experience with an associate’s degree, in claims management, risk management, insurance, litigation support, health care operations, or a related field preferred. Experience managing professional liability or general liability claims in a health care organization, insurance, TPA, legal, self-insured, or complex multi-site environment preferred.
• Supervisory, team lead, or project management experience preferred.
• Working knowledge of professional liability, general liability, claim investigation, litigation management, insurance administration, reserves, settlements, and claim closure processes.
• Strong analytical, organizational, problem-solving, and follow-through skills with the ability to manage competing priorities and deadlines.
• Demonstrated proficiency using claims management systems, spreadsheets, dashboards, or similar reporting tools to maintain data integrity, monitor key metrics, interpret trends, and present concise, actionable information to support leadership decision-making.
• Knowledge of health care operations, patient safety, employee safety, risk mitigation, incident reporting, and regulatory considerations affecting claims management.
• Required travel to Baptist entities, meetings, mediations, claim reviews, or other business locations, as needed.
• Excellent written, verbal, and interpersonal communication skills, including the ability to interact professionally with leaders, physicians, clinicians, team members, vendors, attorneys, insurers, and external agencies.