RN Claims Specialist - Risk Finance

As an RN Claims Specialist at CHRISTUS Health, you will provide extensive support in the investigation, management, resolution, and defense of various claims, appeals, and arbitrations. This includes preparing and analyzing clinical reports, negotiating settlements, attending depositions, and coordinating with external counsel. The role necessitates travel and active participation in risk management reviews, making it essential for candidates to possess both clinical and legal knowledge.

To qualify for the RN Claims Specialist role at CHRISTUS Health, a Bachelor of Science in Nursing (BSN) is required along with RN licensure. Candidates should have 3-5 years of experience in healthcare, ideally with a mix of clinical care and risk management. Legal experience, such as being a Paralegal or Legal Nurse Consultant, is preferred, and additional certifications, like an Adjuster licensure or CPHRM, are a plus.

The RN Claims Specialist role directly supports CHRISTUS Health's mission by ensuring that claims and disputes are managed effectively and ethically, thereby safeguarding the healthcare facilities and providers. By investigating claims and addressing quality and risk issues, the RN Claims Specialist helps minimize adverse occurrences, ultimately enhancing patient safety and care quality throughout the organization.

Successful candidates for the RN Claims Specialist position at CHRISTUS Health should demonstrate strong leadership, organizational, and problem-solving skills. Excellent interpersonal communication abilities are essential for liaising with various stakeholders, and proficiency in computer applications, especially PowerPoint and Excel, is advantageous for preparing reports and presentations.

The work environment for an RN Claims Specialist at CHRISTUS Health is collaborative and dynamic, with opportunities for continuous learning and professional development. You will engage with a diverse team of healthcare professionals and legal experts, participate in risk management surveys, and make educational contributions through teaching. This supportive atmosphere helps you grow while making a significant impact on the quality of healthcare services.

When responding to this question, highlight specific examples where you have analyzed patient complaints, prepared documentation, or assisted in negotiations. Focus on your role in achieving successful outcomes and any collaborative efforts with legal teams or other departments.

In your answer, outline a systematic approach you take to claim investigations, including gathering evidence, interviewing involved parties, and preparing comprehensive reports. Discuss how you prioritize thoroughness and accuracy to ensure fair resolutions.

Share your techniques for managing workloads, such as utilizing project management tools or prioritization methods. Emphasize your ability to track deadlines, documentation, and communications effectively, ensuring no details are overlooked.

Discuss past collaborations with legal counsel, focusing on your role in coordinating and facilitating communication. Provide examples of successful cases where your input directly contributed to positive outcomes for claims management.

Provide insight into your negotiation tactics, stressing the importance of balancing assertiveness with empathy. Use an example where you reached a favorable settlement while maintaining professional relationships with claimants and other parties involved.

Emphasize that patient safety is at the forefront of your decision-making. Explain how assessing claims and understanding risk factors contribute to implementing improvements and preventive measures that enhance overall patient care.

Choose a specific instance where you encountered a particularly complex claim. Discuss your approach to navigating the challenges and the lessons learned from that experience, highlighting your analytical and problem-solving skills.

Talk about any relevant software or tools you’ve utilized in claims management, such as case management systems or reporting software. Specify how these tools aid in streamlining processes and improving efficiency.

Describe your collaborative approach, including your experience in fostering communication and cooperation among team members. Provide an example of a successful team project where your leadership or support improved claims processing.

Outline your aspirations within the field, including any specific areas of claims management you hope to develop further. Highlight your commitment to continuous professional development and how you plan to contribute to your organization's objectives.