Director, Claims Management - 140738

The Director, Claims Management is a key leader within the Risk Management Department responsible for the operational oversight and strategic coordination of the organization's claims liability programs. This position directs and manages professional liability, general liability, and employment practices liability claims across UC San Diego Health's clinical and administrative operations.

The Director, Claims Management serves as the primary operational leader responsible for coordinating claim investigation, litigation management, financial exposure evaluation, and resolution strategies in collaboration with internal stakeholders, defense counsel, and third-party administrators.

This role provides experts guidance on complex liability matters, evaluates litigation risk and settlement strategies, ensures consistent and effective management of claims in alignment with the organization's risk tolerance and operational priorities. The Directors also collaborates closely with clinical leadership, Human Resources, Patient Experience, Compliance, and the Office of Campus Counsel to address claims exposure, support organizational responses to adverse events, and identify opportunities to mitigate future risk.

The position requires strong analytical and strategic judgment in managing complex claims matters that may carry significant legal, financial, operational, and reputational implications for the organization.

KEY RESPONSIBILITIES

Claims Program Leadership

* Provides operational leadership and oversight for the organization's liability claims programs, including professional liability, general liability, and employment practices liability claims.
* Directs claims investigations, evaluation, and resolution activities in collaboration with internal stakeholders, third-party administrators, and/or defense counsel.
* Establishes priorities and workflows to ensure timely and effective claims management and reporting.
* Provides leadership and guidance to claims staff responsible for claims coordination and administrative support.

Litigation Strategy and Case Management

* Collaborates with defense counsel and third-party administrators to develop litigation strategies aligned with organizational objectives and risk tolerance.
* Reviews case evaluations, litigation plans, discovery, and settlement recommendations for complex claims matters.
* Monitors case progress including discovery, mediation, and trial preparation.
* Participates in settlement discussions, mediations, and strategic case review meetings as appropriate.

Organizational Collaboration

* Works closely with clinical leadership, Human Resources, Patient Experience, Compliance, and the Office of Campus Counsel to address claims-related matters and support coordinated responses to adverse events and other liability-creating events.
* Participates in case review meetings, disclosure discussions, and multidisciplinary forums when claims exposure is present.
* Provides subject matter expertise to inform organizational risk mitigation initiatives.
* Assists in the coordination and implementation of corrective action with the appropriate organizational stakeholders.

Claims Reporting and Program Development

* Maintains oversight of claims tracking systems, documentation, and reporting processes.
* Prepares reports and presentations related to claims activity, litigation trends, emerging liability risks, and financial exposure.
* Supports development and implementation of policies and procedures related to claims management.
* Identifies opportunities to improve claims processes and reduce organizational liability exposure.

• Bachelor's degree in healthcare administration, business administration, risk management, or related field.

• Seven or more years or progressively responsible experience in claims management, litigation management, or risk management OR a Juris Doctor and four years of experience.

• Demonstrated experience managing or coordinating claims within a healthcare environment.

• Experience working with third-party administrators and outside legal counsel in the management of liability claims.

• Strong analytical and problem-solving skills with the ability to evaluate complex claims and litigation matters.

• Demonstrated ability to manage competing priorities in a fast-paced environment.

• Excellent communication and interpersonal skills and ability to coordinate with clinical leaders, attorneys, and administrative stakeholders.

• Juris Doctorate

• Certified Professional in Healthcare Risk Management (CPHRM) or similar professional certification.

• Experience in civil litigation within California.

• Experience within an academic medical center or large integrated healthcare system.

• Experience managing multiple liability claim lines including professional liability, general liability, and employment practices liability.

• Experience analyzing claims data to identify risk trends and mitigation opportunities.

• Current UC San Diego employee.

• Must be able to work various hours and locations based on business needs.

• Employment is subject to a criminal background check and pre-employment physical.