Abbott
Healthcare
Manager,PatientClaims
“Manager, Patient Claims at Abbott. Skills: Patient claims management, Legal operations, Regulatory compliance. Manage patient claims lifecycle. Communicate with claimants”
Industry & Context.
Evaluate complex claims; Determine reasonable settlements; Exercise sound judgment; Analyze claims patterns
5% travel
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
Submit Responsible Reporting Entity
Maintain audit-ready case files
Maintain settlement documentation
Maintain correspondence records
Maintain system records
Lead legal team projects
Contribute to process improvement
Contribute to system implementations
Contribute to policy development
Contribute to special investigations
Influence commercial teams
Ensure compliant patient interactions
Contribute to tactical planning
Contribute to execution for high-volume claims
Contribute to advisories
Contribute to recalls
Contribute to patient communications
Analyze industry claims
Analyze Abbott-specific claims
Identify claims 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
Communication Scope
Verbal communication; Written communication; Professional correspondence
Process & Methodology
Process improvement, System implementations, Policy development
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