Claims Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee liability claims, including those related to hospital and employed physician claims, as well as claims falling under deductible policies such as Cyber Liability, D&O/EPL, Regulatory, and Property/ADP.

• Resolve claims within the limits of available insurance coverage to safeguard ministry assets.

• Represent BSMH during pre-trial hearings, mediations, arbitrations, and trials.

• Manage and guide defense counsel in alignment with organizational objectives and goals.

• Independently assess, reserve, and resolve claims and litigation matters within defined authority.

• Utilize risk investigations and expert reviews to analyze liability and causation, establish reserves, evaluate claim values, negotiate settlements, or decide on litigation.

• Assign defense counsel based on the venue, type of claim, and potential claim value.

• Collaborate with defense counsel to manage claims, select medical experts, and determine the appropriateness of proceeding to trial.

• Review bills from outside defense counsel using bill review software in accordance with departmental guidelines.

• Conduct insurance coverage analyses and work in conjunction with insurance staff on coverage-related issues.

• Coordinate with Loss Prevention on claims eligible for the Early Liability Review Program.

• Communicate risk evaluations and resolution or litigation alternatives to market and group senior leaders.

• Clarify the claims and litigation process, along with expert-review analyses, to employed physicians.

• Partner with Risk Management on investigations, discovery, claim valuation, litigation, and resolutions.

• Maintain a diary system to track claims from reporting through investigation, evaluation, discovery, and analysis.

• Obtain defense counsel reports in a timely manner and direct litigation efforts per departmental guidelines.

⛳️ Requirements

• Bachelor’s Degree in Finance, Accounting, Business, or a related field (required).

• A minimum of 3 years of experience managing Professional Liability Claims or equivalent experience (required).

• 5 years of experience in Claims Processing (preferred).

• Associate in Claims (AIC) Certification or Associate in Risk Management (ARM) is preferred.

• Capability to swiftly learn and adapt to contemporary technologies as necessary.

• Mediation training or proven experience in negotiating high-value complex claims.

🏝️ Benefits

• Competitive salary.

• Incentives.

• Referral bonuses.

• 403(b) plan with employer contributions (when eligible).

• Comprehensive medical, dental, vision, and prescription coverage.

• HSA/FSA options available.

• Life insurance.

• Access to mental health resources and discounts.

• Paid time off.

• Parental and FMLA leave.

• Short- and long-term disability coverage.

• Backup care services for children and elders.

• Tuition assistance.

• Support for professional development and continuing education.