Everyone who works with Mercy Health is united under one purpose: to help our patients be well in mind, body and spirit. This drive, along with our history of faith, is a powerful combination. It gives us a shared calling to work toward every day. Join our exceptional team and help us continue to provide the highest quality of health care possible to our communities.

• 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.

• 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.

• 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 recruitment@mercy.com. 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 recruitment@mercy.com