Claims Manager

Job not on LinkedIn

🔥 2 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Bon Secours Mercy Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2018

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Bon Secours Mercy Health is a leading health care organization committed to transforming health care delivery and services through strategic innovation and compassionate care. Operating hospitals and clinical sites in the U. S. and Ireland, the organization focuses on extending health care access, improving patient outcomes, and enhancing value through emerging technologies and strategic partnerships. With a commitment to service and stewardship, Bon Secours Mercy Health also prioritizes enhancing the quality of life for underserved communities while advocating for sustainability. The organization’s initiatives include digital innovation, diversified growth through investments and partnerships, and providing high-value care across its core clinical operations.

📋 Description

• 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

🎯 Requirements

• 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)

🏖️ 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

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