Claims Manager
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Job Description
Claims Manager evaluating and resolving complex healthcare liability claims for Mercy Health. Directing defense counsel, litigation strategy, reserves, coverage analysis, and claim negotiations.
Responsibilities:
- 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
Requirements:
- 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
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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