Risk Specialist

Entity: Owensboro Health System | Department: Risk Management | Work Hours: 0800-1630 week days | Weekend Requirements: N/A | 1.0 FTE

Job Summary:

Supports the organization’s risk management, patient safety, insurance, and claims administration programs through data analysis, financial oversight, and operational coordination.  This position collaborates with internal departments, insurance carriers, third-party administrators, and legal counsel to support claims management, regulatory reporting, budgeting, actuarial reviews, and risk financing initiatives.  The specialist develops reports, dashboards, and trend analyses that inform strategic decision-making and promote a culture of safety and accountability. 

Job Responsibilities:

• Supports the daily operations of the Risk Management Department, including administration of settlement agreements, processing check requests, and coordinating contract review and approval activities.

• Assists with insurance program administration, including completion of insurance applications, preparation of supporting documentation, and certificate of insurance (COI) management and distribution to organizational leadership. 

• Works with Third Party Administrator (TPA) on events, claim submissions, documentation.

• Performs advanced data management and analysis utilizing Microsoft Office applications, with a strong emphasis on Microsoft Excel, including pivot tables, trend analysis, dashboards, and data visualization.

• Collaborates with Patient Financial Services and Revenue Cycle departments to understand billing processes and facilitate appropriate risk management-related billing adjustments, refunds, and financial reconciliations.

• Assists with departmental financial management activities, including budget preparation, expense monitoring, forecasting, invoice processing, and financial reporting.

• Supports the Director of Risk Management with actuarial reviews, insurance renewals, self-insurance program evaluations, and preparation of data for actuarial and underwriting analyses. 

• Performs data analysis and reporting related to risk management, claims, patient safety, grievances, insurance programs, and organizational performance indicators. 

• Coordinates employee driver insurance including but not limited to communication, training, collection of documents, and tracking per insurance requirements.

• Develops, maintains, and distributes reports from the Risk Event Reporting System, including patient events, employee events, grievances, and patient complaints.

• Reviews event reports, identifies trends, and collaborates with operational leaders to ensure timely follow-up and resolution. 

• Assists with the administration, optimization, testing, and ongoing support of the event reporting system in collaboration with IT and operational stakeholders.

• Coordinates the organizational grievance process, including tracking cases, facilitating investigations, scheduling meetings, maintaining documentation, and communicating with patients and families as appropriate.

• Maintains Grievance logs, dashboards, and performance metrics to support regulatory compliance and organizational improvement initiatives.

• Completes additional assignments as directed by the Director of Risk Management.

• Maintains confidentiality of sensitive information and ensures compliance with applicable regulatory, legal, and organizational requirements.

Skills and Attributes:

• Requires critical thinking skills and decisive judgment.

• Ability to exercise sound judgment and manage multiple priorities in a fast-paced environment.

• Strong financial acumen with the ability to interpret data, support budgeting activities, and contribute to insurance and risk financing initiatives.

• Advanced proficiency in Microsoft Office Suite.

• Excellent written, verbal, and interpersonal communication skills.

• Ability to work independently with minimal supervision while effectively collaborating across departments.

• Ability to perform effectively under pressure and respond appropriately to urgent or complex situations.

Position Requirements:

Work Experience

• A minimum of 2 years' relevant experience as determined by the organization preferred.

Education

• Bachelor’s degree or higher in related field required upon hire

    

Licensure/Certification/Registration

• No licensure/certification/registration required         

Organizational Responsibilities:

• Supports Owensboro Health’s Mission, Vision, Core Commitments, and business interests.  Adheres to all organizational policies and procedures. Executes all tasks and behaves in a manner consistent with a culture of compliance, safety and a high reliability organization.

Additional Job Information:

• This job description describes the general nature and level of work required by the position. It is not intended to be an all-inclusive list of qualifications, skills, duties, responsibilities or working conditions of the job. Specific duties and responsibilities consistent with the general nature and level of work described may vary by department and additional related duties may be assigned as needed. Some duties listed may not apply to all employees with this job description. 

• The job description is subject to change with or without notice, and Management reserves the right to add, modify or remove any qualification or duty. Nothing in this job description changes the existing at-will employment relationship between the Organization and the employee occupying the position.

Standard ADA Settings:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical Demands: (Office Environment)

Standing: Occasionally

Walking: Occasionally

Sitting: Frequently

Lifting 0-25 lbs.: Rarely

Lifting 25-75 lbs.: Rarely

Lifting over 75 lbs.: Rarely

Carrying 0-25 lbs.: Rarely

Carrying 25-75 lbs.: Rarely

Carrying over 75 lbs.: Rarely

Pushing/Pulling 0-25 lbs.: Frequently

Pushing/Pulling 25-75 lbs.: Rarely

Pushing/Pulling over 75 lbs.: Rarely

Climbing: Rarely

Bending/Stooping: Rarely

Kneeling: Rarely

Crouching/Crawling: Rarely

Reaching: Occasionally

Talking: Frequently

Hearing: Frequently

Repetitive Foot/Leg Movements: Rarely

Repetitive Hand/Arm Movements: Frequently

Keyboard Data Entry: Frequently

Running: Rarely

Vision: Depth Perception: Frequently

Vision: Distinguish Color: Frequently

Vision: Seeing Far: Frequently

Vision: Seeing Near: Frequently

Hazardous Drug Risk Exposure:

Risk Level: No-Risk

Owensboro Health Core Commitments

INTEGRITY - We conduct ourselves with a high level of responsibility, reliability and honesty because we take seriously the trust of our patients and coworkers.

RESPECT - We value and accept the unique talents and contributions of every patient, customer and team member in the Owensboro Health community.

TEAMWORK - We build a spirit of connectivity and fellowship by striving together to overcome obstacles, surpass goals, celebrate accomplishments and plan the future.

INNOVATION - We foster original ideas and creative solutions that improve our daily work and promote the mission of Owensboro Health.

SERVICE - We focus on service to patients, customers and team members by anticipating their needs, thoughtfully meeting those needs and continually improving the quality of everything we do.

EXCELLENCE - We reach beyond basic expectations to expand our knowledge and awareness, produce exceptional work and provide outstanding service.