Claims Manager

🔥 21 horas atrás

🏈 Ohio – Remoto

🏈 Ohio – Remote

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

👻 Score fantasma 10%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Por que essa pontuação:

• Publicada recentemente.
• As vagas desta empresa costumam ser preenchidas em 21 dias.
• Sem salário divulgado.

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Mercy Health

SiteLinkedInTodas as Vagas

10.000+ funcionários

🏥 Saúde

🤝 Sem Fins Lucrativos

Healthcare • Non-profit

Mercy Health é uma organização de saúde orientada por missão que oferece cuidados diretos ao paciente, serviços de saúde comunitários e uma gama de funções de suporte e administrativas. A organização enfatiza o lado humano do atendimento à saúde, um serviço compassivo e baseado em valores vinculado a uma missão ministerial, desenvolvimento da força de trabalho para a equipe assistencial e de apoio, benefícios flexíveis e alcance comunitário. Mercy Health se posiciona tanto como empregadora quanto provedora de saúde comunitária, focando em dignidade, unidade e serviço social.

Descrição

• Manage liability claims, including hospital and employed physician claims and deductible-policy claims 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 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, assess claim values, and negotiate or resolve claims • Determine when matters should be litigated through trial • Assign and work extensively with outside defense counsel • Select medical experts to review standard of care and causation • Review defense bills using bill review software and department guidelines • Conduct insurance coverage analysis and coordinate with insurance staff on coverage issues • Identify claims for the Early Liability Review Program and monitor timely expert evaluation and notification • 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 claim progression • Obtain defense counsel reports and direct litigation efforts according to department guidelines

🎯 Requisitos

• Bachelors 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 • No language requirement specified

🏖️ 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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