Claims Manager

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

📋 Description

• Oversee liability claims, which include hospital and employed physician claims, as well as deductible-policy claims 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 in pre-trial hearings, mediations, arbitrations, and court trials.

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

• Independently assess, reserve, and resolve claims and litigated issues within assigned authority.

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

• Decide when claims should proceed to litigation.

• Assign and collaborate extensively with external defense counsel.

• Choose medical experts to analyze standard of care and causation.

• Review defense invoices using billing review software and departmental guidelines.

• Conduct insurance coverage assessments and liaise with insurance staff regarding coverage matters.

• Identify claims for the Early Liability Review Program and ensure prompt expert evaluation and notification.

• Communicate risk evaluations and resolution or litigation options to senior leaders in the market and group.

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

• Collaborate with Risk Management on investigations, discovery, claim valuation, litigation, and resolution efforts.

• Maintain a tracking system to monitor claim progression.

• Acquire reports from defense counsel and direct litigation strategies according to 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).

• Preferred 5 years of experience in Claims Processing.

• 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 demonstrated experience in negotiating high-value complex claims.

• No specific language requirement stated.

🏝️ 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 leave and FMLA leave.

• Short- and long-term disability coverage.

• Backup care services for children and elders.

• Tuition assistance.

• Support for professional development.

• Continuing education assistance.