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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.

SUMMARY

Effectively and efficiently manages liability claims, including hospital and employed physician claims, as well as claims covered by the deductible polices, 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 and resolves matters up to the position’s captive program settlement authority limit of $50,000.00. Handles matters up to $500,000.00 in total exposure. May handle higher exposure matters at the System Director’s discretion.

ESSENTIAL JOB FUNCTIONS

+ 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.

QUALIFICATIONS

+ Bachelors degree required.

+ MBA or JD preferred.

+ CPCU, ARM, SCLA, AIC, CCP preferred.

+ 7 years handling Professional Liability Claims or equivalent experience.

+ 10-12 years’ experience in a personal or commercial lines liability claims department preferred.

ADDITIONAL SKILL ITEMS

+ Working with claims databases

+ Attention to detail

+ Working with word processing platforms

+ Acceptance of authority

+ Working with Excel Spreadsheets

+ Critical thinking

+ Contract Analysis

+ Communication with patient, family, or representatives

+ Time Management

+ Negotiation

+ Self-motivated

+ Overcoming objections

+ Recommend and set financial reserves

+ Investigation and evaluation

+ Evaluate liability exposure values

+ Making presentations to ministry leadership

+ Interpreting medical records

+ Building rapport

Many of our opportunities reward* your hard work with:

Comprehensive, affordable medical, dental and vision plans

Prescription drug coverage

Flexible spending accounts

Life insurance w/AD&D

Employer contributions to retirement savings plan when eligible

Paid time off

Educational Assistance

And much more

*Benefits offerings vary according to employment status

All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Mercy Health – Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email [email protected] . If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at [email protected]