At HSG we are serious about selecting the right person for the right position. We look for that special spark in someone who will thrive in our outstanding environment – someone who likes to learn and strives to do better every day.
If you want to pursue your career in a dynamic and collaborative environment built on the strength of dedicated employees with a commitment to success, then HSG is the place for you!
Counsel, Insured Legal Services
JOB PURPOSE:
The Counsel, Insured Legal Services will primarily focus on HIPAA-related regulatory matters, including medical records requests and subpoenas involving PHI. Over time, the role is expected to expand to include additional healthcare regulatory and pre-suit matters, providing broader legal support to insured healthcare providers.
This position works closely with the claims team while communicating directly with healthcare providers, attorneys, and court personnel.
ESSENTIAL DUTIES:
- Independently manage, track, and support insureds in responding to medical records requests, document subpoenas, and traditional subpoenas for court appearances involving PHI.
- Communicate directly with opposing counsel, provider insureds, court personnel, and other stakeholders to ensure requests and responses comply with HIPAA and applicable state privacy laws.
- Analyze subpoenas and related requests to determine validity, scope, objections, and compliance requirements.
- Serve as the primary internal resource for HIPAA-related matters for the claims team, including both setup and direct handling of HIPAA and other regulatory matters.
- Apply standardized decision-tree algorithms and workflows developed in coordination with outside counsel.
- Identify matters requiring escalation to outside counsel or internal leadership and coordinate referrals as appropriate.
- Maintain accurate documentation of requests, responses, deadlines, objections, and compliance determinations.
- Coordinate with medical providers, vendors, and counsel to obtain, review, and transmit records when appropriate.
- Participate in, and over time independently manage, BOHA and BON matters for insured providers that are unrelated to existing lawsuits.
- Support the Director of Claims in routine administrative matters, including claim setup and documentation, thereby enabling greater outward facing engagement with insureds and defense counsel.
CLAIM & RISK MANAGEMENT SUPPORT:
- Remove certain non-claims management-related tasks from claims handlers’ workflows.
- Assist claims handlers with claim intake, documentation, issue spotting, and file organization as time permits.
- Provide support to Risk Management with respect to legal regulatory matters as time permits.
- Assist with internal audits, process improvement initiatives, and training related to HIPAA and subpoena compliance.
- As time permits, move into the area of pre-suit claims handling on a limited basis (PHI-related matters will remain the focus of this position).
REPORTING & DEVELOPMENT:
- Reports to Claims Leadership.
- Receives ongoing mentoring and supervision as needed, with increasing autonomy over time.
- Participates in succession planning and knowledge transfer initiatives, particularly related to pre-suit claims handling and claim setup and documentation.
GENERAL DESCRIPTION:
- Work with insureds (and outside counsel, where needed) to support the timely, accurate, and compliant handling of medical records requests, document subpoenas, and subpoenas for testimony.
- With time, obtain a broader-based understanding of healthcare regulatory matters such that the scope of services handled internally can be expanded—this would include, without limitation, the handling of Board of Healing Arts and Board of Nursing matters that are not directly tied to existing claims.
- Professional and effective communication with opposing counsel and external parties.
- Reduction in external LVAS spend.
- Demonstrated reduction in claims-handler time devoted to subject matter-related tasks.
- Progressive exposure to and competency in pre-suit claims handling by end of Year 1.
- Positive feedback from Claims, Underwriting, and Risk Management.
- Consistent adherence to established compliance workflows and escalation protocols.
MINIMUM REQUIREMENTS:
- Juris Doctor (ideally with at least 5 years of relevant legal, healthcare, or claims experience).
- Demonstrated familiarity with and aptitude for HIPAA, medical records handling, healthcare litigation, subpoenas, and/or insurance claims preferred.
- Comfortable working independently (both substantively and from an administrative support perspective) and communicating directly with opposing counsel and external stakeholders.
- Strong written and verbal communication skills, organizational ability, and attention to detail.
- Ability to exercise sound judgment, follow structured workflows, and escalate issues appropriately.
- Demonstrated ability to work collaboratively with multiple stakeholders—insureds, internal claim handlers, defense counsel, and opposing counsel.
- Self-motivated and comfortable operating in a focused role dedicated initially to the scope of services described above.
Please send your resume to Leslie Jeffries, Director of Human Resources, at ljeffries@hsg-group.com