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About the Role

As a Complex Claims Consultant at CNA, you will manage and resolve complex healthcare claims, acting as a technical expert in policy coverage interpretation. This role involves collaborating with various stakeholders, including insureds, attorneys, and internal business partners, to investigate, negotiate, and settle claims across multiple states. You will work with autonomy to handle professional liability healthcare claims with moderate to high complexity and exposure, ensuring adherence to company protocols and customer service standards.

Responsibilities

Manages an inventory of highly complex commercial claims with large exposures, requiring specialized technical expertise and coordination.
Ensures exceptional customer service by managing all aspects of the claim, interacting professionally, achieving quality and cycle time standards, and providing timely updates.
Verifies coverage and establishes timely and adequate reserves by reviewing policy language and partnering with coverage counsel.
Leads focused investigation to determine compensability, liability, and covered damages by gathering pertinent information and working with experts.
Resolves claims by developing and executing a claim resolution strategy, including managing reserves, negotiating settlements, and partnering with counsel on litigation.
Establishes and manages claim budgets by achieving timely claim resolution and overseeing appropriate resources.
Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences.
Achieves quality standards by managing claims according to company protocols, ensuring accuracy, timeliness, and proper documentation.
Keeps senior leadership informed of significant risks and losses by completing loss summaries and preparing succinct summaries.
Maintains subject matter expertise and ensures compliance with state/local regulatory requirements.
Mentors, guides, develops, and delivers training to less experienced Claim Professionals.
May perform additional duties as assigned.

Requirements

Thorough knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices.
Demonstrated analytical and investigative mindset with critical thinking skills and ability to make sound business decisions.
Ability to work in a fast-paced environment at high levels of productivity.
Ability to manage multiple and shifting priorities in a fast-paced and challenging environment.
Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.
Prior negotiation experience.

Skills

Strong communication and presentation skills both verbal and written.
Ability to communicate business and technical information clearly.
Ability to effectively evaluate and resolve ambiguous, complex and challenging business problems.
Strong work ethic, with demonstrated time management and organizational skills.
Demonstrated ability to negotiate complex settlements.
Experience interpreting complex commercial insurance policies and coverage.
Knowledge of Microsoft Office Suite and ability to learn business-related software.
Demonstrated ability to value diverse opinions and ideas.

Location

Multiple CNA office locations

Work Type

Hybrid

Experience Level

Typically a minimum of six years of relevant experience, preferably in claim handling or medical malpractice litigation.

Education Level

Bachelor's Degree or equivalent experience.
Professional designations preferred (e.g. CPCU).

Salary/Compensations

In District of Columbia, California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $72,000 to $141,000 annually.

Benefits

CNA offers a comprehensive and competitive benefits package to help our employees – and their family members – achieve their physical, financial, emotional and social wellbeing goals.

About the Company

CNA is a market leader in insuring healthcare providers and facilities.
CNA strives to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.

Equal Opportunity

CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process.