Complex Claims Specialist - Healthcare - Dental

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Healthcare Claims is recruiting for a Complex Claim Specialist position to work in our Dental Malpractice segment. Individual contributor responsible for the overall investigation and management of Dental Malpractice 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 high degree of technical complexity, coordination and excellent customer service.
CNA is a market leader in insuring healthcare providers and this role will support the business and interact with key customers and internal business partners. The successful candidate must be collaborative and flexible, able to assume handling of claims at various points, and should have an interest in working with all types of Healthcare provider claims. This individual should have experience with managing medical malpractice claims under both primary and excess or reinsurance policies and should have experience in litigation.
This position is available in any location near a CNA office. CNA operates in a hybrid work environment, with office presence expected 1-2 days/week.
JOB DESCRIPTION:
Essential Duties & Responsibilities:
Performs a combination of duties in accordance with departmental guidelines:

• Manages an inventory of moderate to high complexity and exposure Healthcare claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits.
• Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, timely updates and responding promptly to inquiries and requests for information.
• Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters , estimating potential claim valuation, and following company's claim handling protocols.
• Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims.
• Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate.
• Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service.
• Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU resources for further investigation.
• Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements.
• Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business.
• May serve as a mentor/coach to less experienced claim professionals

May perform additional duties as assigned.
Reporting Relationship
Typically Manager or above
Skills, Knowledge & Abilities

• Solid working knowledge of the Healthcare insurance industry, products, policy language, coverage, and claim practices.
• Solid verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed.
• Demonstrated ability to develop collaborative business relationships with internal and external work partners.
• Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions.
• Demonstrated investigative experience with an analytical mindset and critical thinking skills.
• Strong work ethic, with demonstrated time management and organizational skills.
• Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity.
• Developing ability to negotiate low to moderately complex settlements.
• Adaptable to a changing environment.
• Knowledge of Microsoft Office Suite and ability to learn business-related software
• Demonstrated ability to value diverse opinions and ideas

Education & Experience

• Bachelor's Degree or equivalent experience. Professional designations preferred. J.D. or medical background a plus.
• Typically a minimum four years of relevant experience, preferably in claim handling or equivalent legal experience.
• Candidates with dental claims experience a plus
• Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 years of claim handling experience.
• Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.
• Professional designations are a plus (e.g. CPCU)

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In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In California, Colorado, Connecticut, New York and Washington, the standard base pay range for this role is $43,600 to $159,500 annually.Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. 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. For a detailed look at CNA's benefits, please visit cnabenefits.com .
CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact [email protected] .