Claims Specialist (Registered Nurse)

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