Claims Manager - Risk and Insurance

Overview

At Bon Secours Mercy Health, we are dedicated to continually improving health care quality, safety and cost effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence.

Job Summary

Effectively and efficiently manages liability claims, including hospital and employed physician claims, as well as claims covered by the deductible polices including but not limited to Cyber Liability, D&O/EPL, Regulatory and Property/ADP, to protect the assets of the ministry by resolving those claims within the parameters of the available insurance coverages. Is the BSMH representative at pre-trial hearings, mediations, arbitrations and trials.

Manages and directs defense counsel in accordance with organizational objectives and goals. Independently evaluates, reserves and resolves claims and litigated matters within designated authority.

This is a remote/work from home position. Hire may be asked to travel a few times/year as needed.

• Utilizes risk investigations and expert reviews to evaluate legal liability and causation to set financial reserves, evaluate claim values, and negotiate and resolve claims when indicated or to make the determination to litigate the matter to and through trial when necessary.

• Assigns appropriate defense counsel depending on venue, claim type, and potential claim value. Works extensively with outside defense counsel to manage and resolve claims. Also works with defense counsel to determine whether to take a case to trial versus offer resolution based on department guidelines.

• Works in conjunction with defense counsel to select the appropriate medical experts by specialty to review cases and provide an opinion on the standard of care and causation as required.

• Ensures accurate billing of outside defense counsel through extensive review of defense bills utilizing bill review software and department guidelines to ensure compliance.

• Conducts appropriate insurance coverage analysis for various lines of coverage on each liability claim. Works closely with insurance staff when coverage issues arise.

• Works closely with Loss Prevention to identify potential claims that would qualify for the Early Liability Review Program. This includes monitoring defense counsels’ response for timely expert evaluation and notification to the claims and loss prevention team.

• Sets accurate financial reserves based on experience and reserving formula in a timely manner.

• Works closely with market and group senior leaders to explain the evaluation of risks and alternatives for resolution or litigation regarding various claims.

• Works closely with employed physicians to explain the claims and litigation process when the physicians are named in a lawsuit. Discusses analysis of expert reviews and various pathways to claim resolution.

• Works closely with the Risk management related to claim investigations, legal discovery of information, evaluation of claim value, and management of the litigation and resolution process.

• Maintains a diary system to track claim progression from report through investigation, evaluation, discovery, and analysis.

• Responsible for obtaining defense counsel reports in a timely manner and directing litigation efforts in accordance with department guidelines.

Associate in Claims (AIC) Certification or Associate in Risk Management (ARM) preferred

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)

Ability to quickly learn and adapt to modern technologies as needed

Mediation training or demonstrable experience in negotiation of high value complex claims

As a Bon Secours Mercy Health associate, you re part of a Mission that matters. We support your well-being—personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way.

• Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)

• Medical, dental, vision, prescription coverage, HSA/FSA…