Claims Manager

🔥 21 horas atrás

🇺🇸 Estados Unidos – Remoto (EUA)

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

👻 Score fantasma 10%

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Bon Secours

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10.000+ funcionários

🏥 Saúde

🤝 Sem Fins Lucrativos

Healthcare • Non-profit

A Bon Secours é uma organização de saúde sem fins lucrativos, orientada por sua missão, que enfatiza cuidados clínicos compassivos e serviços de apoio focados na comunidade. A organização recruta e treina funcionários para cuidados ao lado do leito, apoio ao paciente, serviço comunitário e administração, destacando o desenvolvimento da força de trabalho, benefícios flexíveis e uma cultura centrada na dignidade, unidade e serviço. A Bon Secours se apresenta como um sistema de saúde baseado na fé/orientado para o ministério, focado em servir pacientes e comunidades com ênfase no crescimento dos colaboradores e nas recompensas totais.

Descrição

• Manage liability claims, including hospital and employed physician claims and claims covered by deductible policies such as Cyber Liability, D&O/EPL, Regulatory, and Property/ADP • Resolve claims within available insurance coverage parameters to protect ministry assets • Represent BSMH at pre-trial hearings, mediations, arbitrations, and trials • Manage and direct defense counsel in accordance with organizational objectives and goals • Independently evaluate, reserve, and resolve claims and litigated matters within designated authority • Use risk investigations and expert reviews to evaluate liability and causation, set reserves, assess claim values, negotiate resolutions, or determine whether to litigate • Assign defense counsel based on venue, claim type, and potential claim value • Work with defense counsel to manage claims, select medical experts, and determine whether to proceed to trial • Review outside defense counsel bills using bill review software and department guidelines • Conduct insurance coverage analysis and collaborate with insurance staff on coverage issues • Coordinate with Loss Prevention on claims qualifying for the Early Liability Review Program • Explain risk evaluations and resolution or litigation alternatives to market and group senior leaders • Explain the claims and litigation process and expert-review analyses to employed physicians • Collaborate with Risk Management on investigations, discovery, claim valuation, litigation, and resolution • Maintain a diary system tracking claims from report through investigation, evaluation, discovery, and analysis • Obtain defense counsel reports promptly and direct litigation efforts according to department guidelines

🎯 Requisitos

• Bachelor’s Degree in Finance, Accounting, Business, or similar field (required) • 3 years handling Professional Liability Claims or equivalent experience (required) • 5 years Claims Processing (preferred) • Associate in Claims (AIC) Certification or Associate in Risk Management (ARM) preferred • Ability to quickly learn and adapt to modern technologies as needed • Mediation training or demonstrable experience in negotiation of high value complex claims

🏖️ Benefícios

• 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 and continuing education support

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