Complex Claims Consultant - Aging Services​/Medical Malpractice

Overview

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 is a market leader in insuring skilled nursing, assisted living and independent living facilities and this role will support the business and interact closely with internal business partners such as Underwriting, to share claim insights that aid in good underwriting decisions.

Our Healthcare Claims team is seeking a Complex Claims Consultant to support our Aging Services segment. This individual contributor role is responsible for the overall investigation and management of Aging Services 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.

This position enjoys a flexible, hybrid work schedule and is available in any location near a CNA office.

JOB DESCRIPTION:

• Manages an inventory of highly complex commercial claims with large exposures that require specialized technical expertise and coordination, verifying policy coverage, conducting investigations, developing and employing resolution strategies, and authorizing disbursements within authority limits.
• Ensures exceptional customer service by managing all aspects of the claim, interacting professionally, achieving quality and cycle time standards, providing timely updates, and responding promptly to inquiries.
• Verifies coverage and establishes timely reserves by reviewing policy language and partnering with coverage counsel on more complex matters, estimating potential claim valuation, and following claim handling protocols.
• Leads focused investigations to determine compensability, liability and covered damages by gathering information, taking statements, and coordinating with experts or other parties as necessary to verify facts.
• Resolves claims by collaborating with internal and external partners to develop and execute a claim resolution strategy, managing reserves, negotiating settlements, and authorizing payments within scope of authority.
• Establishes and manages claim budgets by achieving timely resolutions, overseeing resources, and delivering high quality service efficiently.
• Addresses subrogation, salvage opportunities or potential fraud by evaluating facts and referring to appropriate resources for further investigation.
• Maintains quality standards by following company protocols, ensuring accuracy and timeliness, proper documentation, and timely resolution and payment of claims.
• Keeps senior leadership informed of significant risks and losses by completing loss summaries and presenting succinct updates to senior management.
• Maintains subject matter expertise and compliance with state/local regulatory requirements by staying current on commercial insurance laws, regulations, and trends for the line of business.
• Mentors and trains less experienced Claim Professionals.

May perform additional duties as assigned.

Typically Director or above

• Thorough knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices.
• Strong communication and presentation skills, both verbal and written, including the ability to convey business and technical information clearly.
• Analytical and investigative mindset with critical thinking skills to evaluate and resolve complex problems.
• Strong work ethic with time management and organizational skills.
• Ability to work in a fast-paced environment at high levels of productivity.
• Demonstrated ability to negotiate complex settlements.
• Experience interpreting complex commercial insurance policies and coverage.
• Ability to manage multiple and shifting priorities in a fast-paced environment.
• Knowledge of Microsoft Office and ability to learn…