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Today

Claims Specialist (Registered Nurse)

Christus Health Tyler, TX

Tyler, TX

Today

Full time Claims Management Healthcare Claims Insurance

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Job Description

CHRISTUS Health is seeking a Regional Claims Specialist (Registered Nurse) to represent the organization, its facilities, and providers across claims-related matters. Based in Tyler, TX (onsite), this role supports the Vice President of Litigation and the Claims Team in investigating, managing, resolving, and defending disputes, including matters that move from pre-litigation into active litigation.

The position also serves as a liaison to affiliated health care centers, connecting clinical insight with risk and legal strategy while helping the team evaluate complaints, support defense efforts, and contribute to ongoing quality and risk improvement.

Key Responsibilities

Meets expectations of the applicable OneCHRISTUS Competencies, including Leader of Self, Leader of Others, or Leader of Leaders.
Supports the Vice President of Litigation, other Clinical Regional Claims Managers, and the Claims Team in investigating, managing, resolving, and defending liability events, claims, appeals, arbitrations, and related disputes.
Evaluates and investigates patient and claimant complaints and demands, providing recommendations for handling and, when appropriate, conducting on-site provider interviews.
Prepares privileged work product reports that include clinical analysis, along with recommendations to support case handling.
When within designated authority, negotiates settlements and prepares settlement agreements using language approved by the CHRISTUS Vice President of Litigation.
Attends depositions, trials, hearings (as needed), and mediations; negotiates settlements at mediation or directly with claimant or plaintiff’s counsel within designated authority; drafts settlement agreements and performs analysis of MMSEA issues.
Identifies and evaluates trends through report analysis of quality and risk issues to help reduce preventable adverse occurrences, and prepares presentations for facility leadership on trends and improvement recommendations.
Investigates assigned Events, UPLE, Injured Asserts, Attorney Asserts, Medical Review Panels, and Suits.
Provides oversight of defense of claims in collaboration with defense counsel and defense teams.
Recommends reserves and adjustments based on follow-up investigation findings.
Delivers liability analysis and investigative support to defense counsel as litigation is commenced.
Prepares status reports and other presentations for active claims based on regional assignments.
Monitors trials, mock trials, jury studies, and depositions, then provides analysis and recommendations regarding litigation management to the Vice President of Litigation.
Monitors and participates in MMSEA compliance and reporting with support of internal and external counsel.
Monitors Outside Counsel compliance with guidelines and billing requirements.
Interacts regularly with external attorneys regarding oversight and management of claims and litigation matters.
Coordinates, plans, and participates in facility claims reviews.
Participates in teaching events across the system as needed, including teaching nursing residents on matters related to legal claims.
Participates in risk management surveys of facilities.

Qualifications

BSN required
RN required
3 to 5 years in a health care setting with exposure to clinical care, risk management, or operations
Some legal experience (for example, Paralegal or Legal Nurse Consultant) preferred
Paralegal Certificate preferred; JDs will be considered
Adjuster licensure and/or CPHRM certification a plus
Organizational, leadership, and problem-solving skills
Computer literacy; PowerPoint/Excel skills a plus
Demonstrated organizational and interpersonal skills
Enjoys teaching and public speaking

Work Details

Location: Tyler, TX (onsite)
Work type: Full Time
Schedule: 5 Days - 8 Hours
Travel: 25-30%

Tools and Technologies

PowerPoint
Excel

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Today

Claims Specialist (Registered Nurse) - Risk Finance

Christus Health Irving, TX

Irving, TX

Today

Full time Claims Management Healthcare Claims Healthcare Claims Analytics

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Job Description

The CHRISTUS Regional Claims Specialist (Registered Nurse) represents CHRISTUS Health and its facilities and providers in the investigation, management, resolution, and defense of claims and disputes. This onsite role supports the Vice President of Litigation and the Claims Team, including work in pre-litigation and active litigation settings across affiliated health care centers.

Based in Irving, TX, the position partners clinical knowledge with legal claim management, from complaint review and investigative reporting to deposition, trial, mediation, and settlement documentation within designated authority.

Key Responsibilities

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
Supports the Vice President of Litigation, other Clinical Regional Claims Managers, and the Claims Team with the investigation, management, resolution, and defense of liability events, claims, appeals, arbitrations, and other disputes.
Evaluates and investigates patient and claimant complaints and demands, including on-site provider interviewing when needed, and communicates handling recommendations.
Prepares privileged work product reports with clinical analysis and provides recommendations to the team.
When appropriate, negotiates settlements within designated authority and prepares settlement agreements using settlement agreement language approved by the CHRISTUS Vice President of Litigation.
Attends depositions, trials, hearings (as needed), and mediations; negotiates settlements at mediation or directly with claimant or plaintiff’s counsel within designated authority; drafts settlement agreements; analyzes MMSEA issues.
Identifies and evaluates trends through reporting analysis of quality and risk issues to help reduce the frequency of preventable adverse occurrences, and prepares presentations to facility leadership with trends and improvement recommendations.
Investigates assigned Events, UPLE, Injured Asserts, Attorney Asserts, Medical Review Panels, and Suits.
Provides oversight of defense activities by coordinating with defense counsel and defense teams.
Recommends reserves and adjustments based on follow-up investigation.
Delivers liability analysis and investigative support to defense counsel at the start of litigation.
Prepares status reports or other presentations for active claims aligned to regional assignments.
Monitors trials, mock trials, jury studies, and depositions, and provides analysis and recommendations regarding litigation management to the Vice President of Litigation.
Monitors and participates in MMSEA compliance and reporting with support from internal and external counsel.
Monitors Outside Counsel compliance with guidelines and billing requirements.
Interacts regularly with external attorneys regarding the oversight and management of claims and litigation matters.
Coordinates, plans, and participates in facility claims reviews.
Participates in system teaching events as needed, including teaching nursing residents on legal claims topics.
Participates in risk management surveys of facilities.
Serves as a liaison to all affiliated health care centers in the investigation, resolution, and defense of claims.

Requirements

BSN required
RN required
3 years minimum experience
Paralegal Certificate preferred; JDs will be considered
Adjuster licensure and/or CPHRM certification is a plus
Must have organizational, leadership, and problem-solving skills
Computer literacy required; PowerPoint/Excel skills are a plus
Demonstrated organizational and interpersonal skills
Enjoys teaching and public speaking

Technologies

PowerPoint
Excel

Work Schedule and Type

Full Time
5 Days - 8 Hours

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Healthcare Claims Finance Jobs

Claims Specialist (Registered Nurse)

Claims Specialist (Registered Nurse) - Risk Finance

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