Mercy Health · 18 hours ago
Claims Manager - Risk and Insurance
United States
Full-time
Remote
Mid, Senior Level
3+ years expMercy Health is dedicated to helping patients be well in mind, body, and spirit. The Claims Manager will effectively manage liability claims and represent the organization at various legal proceedings, ensuring claims are resolved within insurance coverage parameters.
Health CareNon Profit
Responsibilities
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
Qualification
Required
Bachelors Degree in Finance, Accounting, Business, or similar field
3 years handling Professional Liability Claims or equivalent experience
Preferred
Associate in Claims (AIC) Certification or Associate in Risk Management (ARM)
5 years Claims Processing
Ability to quickly learn and adapt to modern technologies as needed
Mediation training or demonstrable experience in negotiation of high value complex claims
Benefits
Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
Medical, dental, vision, 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 and continuing education support
Company
Mercy Health
Mercy Health is a mission-driven, integrated healthcare organization.
10001+ employees
Funding
Current Stage
Late StageTotal Funding
$0.05MKey Investors
Appalachian Regional Commission
2024-09-18Grant· $0.05M
Leadership Team
Kenneth James
Market Chief Operating Officer, Cincinnati
Staci Lucius
President, Mercy Health Physicians
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