Claims Handler

Job description

Job responsibilities

Develop and maintain accurate and effective systems in respect of the Trusts claims management service (excluding motor and employment tribunal claims), in accordance with legal requirements and accepted good practice.

Handle a caseload of claims, liaising with solicitors, insurance investigators, the NHS Resolution and other parties within and outside the Trust as appropriate.

Investigate the circumstances of claims to support the Head of Governance, Senior Claims Handler, NHS Resolution or their solicitors and obtain the necessary documentation and explanations from staff across EMAS to support the Trusts position in responding to the claim.

Highlight all new claims and claims progress to the Head of Governance or Senior Claims Handler, advising of any concerns or developments to ensure risk management action can be taken as necessary.

Accurately input claims information onto claims/disclosure spreadsheets and the Ulysses incident management system to record all activity relating to the claim.

Implement the Claims Procedure within the Claims Team and across the Trust as required.

Provide practical support and advice to managers and staff in relation to statement taking and/or investigation as appropriate to the complexity of the case.

Prepare synopsis reports for clinical negligence and other claims as appropriate.

Process requests for disclosure of health records and other documents as requested by NHS Resolution, solicitors, or (potential or actual) litigants in person in accordance with the relevant legislation (Pre-action Protocol for Clinical Disputes, General Data Protection Regulations, the Data Protection Act, Access to Health Records Act).

Prepare claims reports, including statistical and financial information, to support effective planning of the claims function and to identify areas of risk .

Record and monitor the cost of claims and associated legal costs, reporting on expenditure and lessons learned.

With the Head of Governance and Senior Claims Handler develop and maintain links between claims, complaints and risk management to ensure that learning can take place across the Trust.

Respond to enquiries received from outside bodies such as the NHS Resolution or solicitors.

Liaise with key managers within the Trust to obtain information needed to investigate claims.

Produce documentation to support payment requests and present to the Head of Governance for authorisation.

Extract the appropriate information from the Claims database and Payments Tracker to create the month-end Finance Provision Reconciliation and work with the Finance team and NHS Resolution to resolve any queries.

Maintain a record of payment requests and authorisations.

Attend meetings, seminars and training as necessary for the purpose of personal development and share learning with the team.

Person Specification

Essential criteria

Essential

• GCSE (or equivalent) in English and Maths (minimum grade C/4 or above). NVQ level 3 or equivalent qualification or equivalent experience
• Experience of undertaking investigations, identifying implications for an organisation and recommending action to limit damage or risk. Experience of maintaining legal/claims administrative systems and maintaining confidential records. Experience of managing shared electronic filing systems. Experience of working with staff of all levels.
• Knowledge of a range of administrative procedures acquired through relevant training and experience. A good working knowledge of Microsoft Office software, including Outlook, Word Excel and Teams.
• Excellent verbal and written communication skills. Demonstrates an ability to work well under pressure. Ability to monitor and plan in advance own workload and prioritise according to the needs of the organisation. Good level of literacy and numeracy skills, with the ability to understand, record, communicate and analyse verbal and written information. Excellent organisational and time management skills with the ability to work accurately and to high standards, particularly when under pressure. Self-motivated and pro-active team-player with the ability to work independently and without direct supervision. Ability to deal confidently and professionally with internal and external queries, referring on as appropriate. Ability to deal sensitively with other members of staff and have the discretion to deal with confidential issues. Ability to set standards and motivate staff to improve systems and services. Willingness to undertake further training and continually develop in a professional manner.
• A self-motivated and pro-active team-player with the ability to work on own initiative as well as part of a team. High degree of integrity, accountability and respect for the sensitive and confidential nature of the work undertaken. Possess a flexible, enthusiastic and positive attitude. Calm and measured, able to manage challenging situations and remain objective. Able to work closely with staff from across the Trust. Is able to occasionally travel to other locations.

Desirable

• Microsoft Office qualification
• Experience of working with service users or their representatives.

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

Employer details

Employer name

East Midlands Ambulance Service NHS Trust

Address

Either office based or home based with an occasional requirement to work in the Nottingham office

1 Horizon Place, Mellors Way

Nottingham

NG8 6PY

Employer's website

https://www.emas.nhs.uk/ (Opens in a new tab)