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 under deductible policies.

• Safeguard ministry assets by settling claims within the parameters of available insurance coverage.

• Represent Bon Secours Mercy Health 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 litigated matters within assigned authority.

• Utilize risk investigations and expert reviews to evaluate liability and causation, establish reserves, assess claim values, and negotiate or settle claims.

• Determine the appropriateness of proceeding to litigation and trial.

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

• Collaborate with external defense counsel to manage and resolve claims, as well as to formulate trial versus settlement strategies.

• Identify suitable medical experts to review cases and provide opinions regarding standard of care and causation.

• Examine defense bills utilizing bill review software and departmental guidelines.

• Conduct insurance coverage analysis across various coverage lines.

• Coordinate with insurance personnel regarding coverage matters.

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

• Promptly set accurate financial reserves using experience and reserving methodologies.

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

• Clarify claims and litigation processes to employed physicians involved in lawsuits.

• Work closely with Risk Management on investigations, discovery, claim valuation, litigation, and resolution.

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

• Obtain reports from defense counsel and direct litigation efforts in accordance with departmental guidelines.

⛳️ Requirements

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

• Minimum of 3 years of experience in handling Professional Liability Claims or equivalent experience (required).

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

• Preferred 5 years of experience in Claims Processing.

• Ability to swiftly learn and adapt to modern technologies as necessary.

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

• Scheduled weekly hours: 40.

• Work shift: Days (United States of America).

🏝️ Benefits

• Competitive pay.

• Incentives.

• Referral bonuses.

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

• Medical, dental, vision, and prescription coverage.

• HSA/FSA options.

• Life insurance.

• Mental health resources and discounts.

• Paid time off.

• Parental and FMLA leave.

• Short- and long-term disability.

• Backup care for children and elders.

• Tuition assistance.

• Professional development support.

• Continuing education support.