Claims Services Consultant

Join Carilion Clinic as a Claims Consultant – Advance Your Career in Healthcare Litigation Management

Carilion Clinic is seeking a detail-oriented and experienced Claims Consultant to support our Director of Claims in managing professional and general liability claims within a dynamic healthcare environment. This role plays a key part in litigation management, compliance, and risk mitigation for one of Virginia’s leading healthcare systems.

As a Claims Consultant, you will independently manage 50-60% of open malpractice and liability claims while serving as a resource and mentor to Claims Specialists. You’ll collaborate with legal counsel, healthcare providers, and internal stakeholders to ensure effective claims handling, regulatory compliance, and risk management.

Key Responsibilities:

• Lead the litigation management process for professional liability and general liability claims in coordination with the Director of Claims.
• Serve as the primary liaison with external defense attorneys, ensuring smooth communication and case coordination.
• Conduct thorough investigations at the direction of legal counsel, gathering critical documentation, medical records, and evidence for active claims.
• Coordinate and attend depositions, legal hearings, and provider preparation meetings.
• Oversee the Attorney Assist Process to ensure compliance with HIPAA and legal standards before engaging external counsel.
• Produce loss-run reports, claims management letters, and support audit responses for BRIC insured providers, ensuring alignment with regulatory and governmental requirements.
• Perform claims data trend analysis, reporting insights to leadership and escalating risk patterns as needed.
• Manage insurance verification and claims history requests for current and former physicians, residents, and mid-level providers, supporting credentialing and reappointment processes.
• Collaborate with risk managers, department heads, and physicians upon notification of malpractice filings, potential compensatory events, or attorney representation.
• Ensure compliance with internal policies, legal requirements, and industry best practices in all aspects of claims consulting and litigation support.