Claims Manager

🕒 Ontem

🇺🇸 Estados Unidos – Remoto (EUA)

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

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Bon Secours Mercy Health

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 2018

🏥 Saúde

⚕️ Seguro de Saúde

Healthcare • Healthcare Insurance

Bon Secours Mercy Health é uma organização líder em cuidados de saúde comprometida com a transformação dos serviços e da prestação de cuidados de saúde através da inovação estratégica e do cuidado compassivo. Operando hospitais e locais clínicos nos EUA e na Irlanda, a organização foca em estender o acesso à saúde, melhorar os resultados dos pacientes e aumentar o valor por meio de tecnologias emergentes e parcerias estratégicas. Com um compromisso com o serviço e a gestão responsável, Bon Secours Mercy Health também prioriza a melhoria da qualidade de vida para comunidades carentes enquanto defende a sustentabilidade. As iniciativas da organização incluem inovação digital, crescimento diversificado por meio de investimentos e parcerias, e fornecimento de cuidados de alto valor em suas operações clínicas principais.

Descrição

• Manage liability claims, including hospital and employed physician claims and claims covered by deductible policies • Protect ministry assets by resolving claims within available insurance coverage parameters • Represent Bon Secours Mercy Health at pre-trial hearings, mediations, arbitrations, and trials • Manage and direct defense counsel according to 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, evaluate claim values, and negotiate or resolve claims • Determine when matters should proceed to litigation and trial • Assign defense counsel based on venue, claim type, and potential claim value • Work with outside defense counsel to manage and resolve claims and determine trial versus settlement strategy • Select appropriate medical experts to review cases and provide opinions on standard of care and causation • Review defense bills using bill review software and department guidelines • Conduct insurance coverage analysis across various lines of coverage • Coordinate with insurance staff on coverage issues • Work with Loss Prevention on claims qualifying for the Early Liability Review Program • Set accurate financial reserves promptly using experience and reserving formulas • Explain risk evaluations and resolution or litigation alternatives to market and group senior leaders • Explain claims and litigation processes to employed physicians named in lawsuits • Coordinate 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 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) • Associate in Claims (AIC) Certification or Associate in Risk Management (ARM) preferred • 5 years Claims Processing preferred • Ability to quickly learn and adapt to modern technologies as needed • Mediation training or demonstrable experience in negotiation of high value complex claims • Scheduled weekly hours: 40 • Work shift: Days (United States of America)

🏖️ 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 support • Continuing education support

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