Abbott

Healthcare

Manager,PatientClaims

$129–259k Plymouth, Minnesota, United States; Austin, Texas, United States; Sylmar, California, United States FULL TIME
The Brief

“Manager, Patient Claims at Abbott. Skills: Patient claims management, Legal operations, Regulatory compliance. Manage patient claims lifecycle. Communicate with claimants”

What You'll Achieve.

Protect legal interests; Protect regulatory interests; Protect financial interests; Protect reputational interests; Ensure complete reporting; Ensure timely reporting; Ensure accurate reporting

Industry & Context.

Healthcare
Problems you'll solve

Evaluate complex claims; Determine reasonable settlements; Exercise sound judgment; Analyze industry claims

Eligibility Requirements

5% travel, Continuous sitting, Keyboard use

What They're Looking For.

Must Have

Bachelor's Degree, 5+ years claims experience, 5+ years medical device legal operations, 5+ years insurance claims, 5+ years risk management, 5+ years regulated environment, Evaluate medical claims, Resolve medical claims, Evaluate technical claims, Resolve technical claims, Evaluate regulatory claims, Resolve regulatory claims

Nice to Have

Experience in medical devices, Experience in pharmaceuticals, Experience in FDA-regulated industries, Paralegal Certification, Investigative skills, Medical record review, Experience in CMS Section 111 reporting

What You'll Do.

Manage patient claims lifecycle

Communicate with claimants

Request necessary consents

Request necessary documents

Deliver claim decisions

Escalate regulatory risk

Escalate litigation risk

Investigate medical records

Investigate operative notes

Investigate product history

Investigate complaint data

Investigate field reports

Investigate physician information

Investigate hospital information

Determine product involvement

Determine claim valuation

Assess potential exposure

Develop settlement recommendations

Manage claim timelines

Manage claim resources

Manage cross-functional workflows

Ensure timely resolution

Ensure regulatory compliance

Negotiate settlements

Escalate novel matters

Escalate complex matters

Escalate high-exposure matters

Ensure FDA compliance

Ensure US privacy compliance

Ensure HIPAA compliance

Ensure anti-kickback compliance

Oversee CMS reporting

Ensure accurate RRE submissions

Maintain audit-ready case files

Maintain settlement documentation

Maintain correspondence records

Maintain system records

Lead legal team projects

Contribute to legal team projects

Conduct special investigations

Influence commercial teams

Ensure compliant patient interactions

Contribute to tactical planning

Contribute to execution planning

Analyze claims for patterns

Recommend process enhancements

Recommend risk mitigation strategies

Train stakeholders on best practices

How You'll Work.

Team & Collaboration

Cross-functional workflows; Cross-functional teams; Multiple stakeholders; Commercial teams

Communication Scope

Verbal communication; Written communication; Empathetic communication

Process & Methodology

Process improvement, System implementations, Policy development

Free ATS check

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