What are the responsibilities and job description for the Professional Liability Claims Specialist position at VCU Health?
The Professional Liability Claims Specialist supports VCU Health’s professional liability program through coordinated claims investigation, litigation support, regulatory compliance, and administrative oversight. This role serves as a key liaison among covered providers, legal counsel, internal departments, and external agencies to ensure accurate, timely, and compliant handling of medical malpractice claims. The Specialist integrates investigative, documentation, financial, and reporting activities to support risk mitigation and informed decision-making related to claim resolution.
Essential Job Statements
Claims Investigation & Litigation Support
Obtain, organize, and maintain comprehensive medical records, medical bills, imaging studies, and related documentation in accordance with federal/state regulations and VCUHS policies.
Serve as a primary point of contact for covered providers, attorneys, claimants, and internal stakeholders to gather information needed to assess and defend claims.
Partner with outside defense counsel to support discovery responses and case preparation.
Collaborate with the Professional Liability Nurse Investigator, Health Information Management, Revenue Cycle, and clinical departments.
Claims Monitoring, Reporting & File Management
Monitor local courts for filings involving covered providers and retrieve pleadings and court documents.
Maintain accurate electronic claim files in claims management system (Origami) and selected hard-copy materials.
Process CMS monthly queries and quarterly reporting related to professional liability claims.
Regulatory, Committee & Administrative Coordination
Coordinate Self-Insurance Committee and Claims Committee meetings and documentation.
Manage Department of Health Professions investigations and subpoena documentation.
Maintain coverage rosters and generate certificates of coverage, verification letters, and claims histories.
Financial Processing & Claims Payments
Process legal, expert, vendor, and claim-related invoices.
Ensure accurate and timely recording of all financial transactions in claims management system.
Post settlement payments related to physician or hospital indemnity.
Customer Service & Professional Communication
Provide timely, professional communication with internal and external stakeholders.
Notarize documents as required for litigation and regulatory support.
Patient Population: N/A
Employment Qualifications
Education Required: High School Diploma or equivalent
Education Preferred: Associate’s degree in Business, Legal Studies, Health Information Management, or a closely related field.
Licensing/ Certification
Licensure Required: Virginia Notary Public Commission License (must obtain within 60 days of hire)
Licensure Preferred: N/A
Certification Required: N/A
Certification Preferred:Certified Paralegal (CP) credential from the National Association of Legal Assistants (NALA).
Minimum Qualifications
Years and Type of Required Experience: Minimum of three (3) years of experience in any of the following environments: Insurance claims, Medical billing or coding, Medical records management, Healthcare administration, Legal office or administrative support
Preferred Experience: Experience working in a legal setting, particularly within personal injury, medical malpractice (plaintiff or defense), or insurance defense. Previous experience within a healthcare system or clinical operational environment. Prior exposure to claims databases or electronic case management platforms (e.g., Origami or similar systems).
Other Knowledge, Skills and Abilities Required: Ability to obtain, organize, analyze, and maintain medical records and billing documents with high attention to detail. Strong organizational and time‑management skills with the ability to manage multiple priorities in a fast‑paced environment. Clear and professional written and verbal communication skills. Ability to interact with physicians, attorneys, patients/families, and internal departments with professionalism and discretion. Strong reasoning, analytical, and problem‑solving abilities. Demonstrated proficiency using personal computers and software applications such as Microsoft Office, email platforms, and document management systems.
Knowledge, Skills and Abilities Preferred: N/A
Working Conditions: Periods of high stress and fluctuating workloads may occur. May have periods of constant interruptions. Prolonged periods of working alone.
Physical Requirements
Physical Demands: N,A
Work Position: Sitting, Walking, Standing
Additional Physical Requirements/ Hazards
Physical Requirements: N/A
Hazards: N/A
Mental/Sensory – Emotional
Mental/Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking,
Emotional: Steady Pace, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Able to Adapt to Frequent Change
Days
EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.
Essential Job Statements
Claims Investigation & Litigation Support
Obtain, organize, and maintain comprehensive medical records, medical bills, imaging studies, and related documentation in accordance with federal/state regulations and VCUHS policies.
Serve as a primary point of contact for covered providers, attorneys, claimants, and internal stakeholders to gather information needed to assess and defend claims.
Partner with outside defense counsel to support discovery responses and case preparation.
Collaborate with the Professional Liability Nurse Investigator, Health Information Management, Revenue Cycle, and clinical departments.
Claims Monitoring, Reporting & File Management
Monitor local courts for filings involving covered providers and retrieve pleadings and court documents.
Maintain accurate electronic claim files in claims management system (Origami) and selected hard-copy materials.
Process CMS monthly queries and quarterly reporting related to professional liability claims.
Regulatory, Committee & Administrative Coordination
Coordinate Self-Insurance Committee and Claims Committee meetings and documentation.
Manage Department of Health Professions investigations and subpoena documentation.
Maintain coverage rosters and generate certificates of coverage, verification letters, and claims histories.
Financial Processing & Claims Payments
Process legal, expert, vendor, and claim-related invoices.
Ensure accurate and timely recording of all financial transactions in claims management system.
Post settlement payments related to physician or hospital indemnity.
Customer Service & Professional Communication
Provide timely, professional communication with internal and external stakeholders.
Notarize documents as required for litigation and regulatory support.
Patient Population: N/A
Employment Qualifications
Education Required: High School Diploma or equivalent
Education Preferred: Associate’s degree in Business, Legal Studies, Health Information Management, or a closely related field.
Licensing/ Certification
Licensure Required: Virginia Notary Public Commission License (must obtain within 60 days of hire)
Licensure Preferred: N/A
Certification Required: N/A
Certification Preferred:Certified Paralegal (CP) credential from the National Association of Legal Assistants (NALA).
Minimum Qualifications
Years and Type of Required Experience: Minimum of three (3) years of experience in any of the following environments: Insurance claims, Medical billing or coding, Medical records management, Healthcare administration, Legal office or administrative support
Preferred Experience: Experience working in a legal setting, particularly within personal injury, medical malpractice (plaintiff or defense), or insurance defense. Previous experience within a healthcare system or clinical operational environment. Prior exposure to claims databases or electronic case management platforms (e.g., Origami or similar systems).
Other Knowledge, Skills and Abilities Required: Ability to obtain, organize, analyze, and maintain medical records and billing documents with high attention to detail. Strong organizational and time‑management skills with the ability to manage multiple priorities in a fast‑paced environment. Clear and professional written and verbal communication skills. Ability to interact with physicians, attorneys, patients/families, and internal departments with professionalism and discretion. Strong reasoning, analytical, and problem‑solving abilities. Demonstrated proficiency using personal computers and software applications such as Microsoft Office, email platforms, and document management systems.
Knowledge, Skills and Abilities Preferred: N/A
Working Conditions: Periods of high stress and fluctuating workloads may occur. May have periods of constant interruptions. Prolonged periods of working alone.
Physical Requirements
Physical Demands: N,A
Work Position: Sitting, Walking, Standing
Additional Physical Requirements/ Hazards
Physical Requirements: N/A
Hazards: N/A
Mental/Sensory – Emotional
Mental/Sensory: Strong Recall, Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking,
Emotional: Steady Pace, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Able to Adapt to Frequent Change
Days
EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.