Complex Claims Consultant - Healthcare

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive 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.
CNA seeks to offer a comprehensive and competitive benefits package to our employees that helps them - and their family members - achieve their physical, financial, emotional and social wellbeing goals.
For a detailed look at CNA's benefits, check out our Candidate's Guide .
Healthcare Claims is recruiting for a Complex Claim Consultant position to work in our Allied Healthcare Providers segment. This individual contributor is responsible for the overall investigation and management of complex Allied Healthcare Providers claims in multiple states. Recognized as a technical expert in the interpretation of complex or unusual policy coverages in area of expertise. Under general management direction, works within assigned limits of broad authority on assignments requiring a higher degree of technical complexity, coordination and excellent customer service. This individual will also work closely with internal business partners, such as Underwriting, to share claim insights to aid in good underwriting decisions. CNA is a market leader in insuring allied healthcare providers and this role will support the business and interact with these key customers.
This position is available in any location near a CNA office.
JOB DESCRIPTION:
Essential Duties & Responsibilities

• Interprets complex and unusual policy coverages and determines if coverages apply to claims submitted, escalating issues as needed.
• Sets reserves and authorizes payments within scope of authority. Ensures issuance of disbursements while managing loss costs and expenses.
• Coordinates and performs investigations and evaluates claims and suits through contact with insureds, claimants, business partners, witnesses and experts.
• Implements an appropriate resolution strategy, seeking early resolution opportunities where appropriate.
• Identifies files that have potential fraud and refers to SIU.
• Utilizes negotiation skills to develop complex settlement packages.
• Identifies claims with third party recovery potential and coordinates with subrogation/salvage unit.
• Partners with attorneys, account representatives, agents, underwriters, doctors, nurse case managers, insureds and other insurers to develop a focused strategy for timely and cost effective resolution of more complex claims.
• Analyzes claims activities. Prepares and presents reports for management and internal business partners. May be responsible for special projects and presentations.
• Responsible for input of data that accurately reflects claim circumstances and other information important to our business outcomes.
• Provides guidance and assistance to less experienced claims staff and other functional areas.
• Keeps current on state/territory regulations and issues as well as industry activity and trends.
• May perform additional duties as assigned.

Reporting Relationship: Manager or Director
Skills, Knowledge & Abilities

• Advanced knowledge of claims and insurance industry theory and practices.
• Demonstrated technical expertise and product specific knowledge.
• Strong interpersonal, communication and negotiation skills. Ability to effectively interact with all levels of CNA's internal and external business partners.
• Ability to work independently, managing time and resources effectively to accomplish multiple tasks and meet deadlines.
• Strong analytical and problem solving skills enabling creative and viable alternative solutions.
• Ability to exercise independent judgement and make critical business decisions effectively assessing the merits of claims as well as evaluating claims based on a cost benefit analysis.
• Solid knowledge of Microsoft Office Suite as well as other business-related software.
• Ability to adapt to change and value diverse opinions and ideas.
• Ability to fully comprehend claim information; and to effectively articulate analyses of claims in internal reports and presentations.
• Ability to handle claims with a proactive long-term view of business goals and objectives.

Education & Experience

• Bachelor's degree or equivalent experience. Professional designations preferred. J.D. or medical background a plus.
• Typically a minimum five to seven years claims experience or equivalent legal experience.
• Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable
• Prior negotiation experience Professional designations preferred (e.g. CPCU)

#LI-MM1
#LI-Hybrid
CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact [email protected] .