Complex Claims Specialist - Allied Healthcare Providers

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.

Start the next chapter of your career as a Complex Claims Specialist focused on Allied Healthcare Providers for CNA Insurance. CNA is a market leader in insuring Allied Healthcare Providers, including nurses, nurse practitioners, physical therapists, counselors, pharmacists, massage therapists and more than 100 other categories of medical service providers. This role will support the business and interact with these key customers.

You will be responsible for the overall investigation, management and resolution of Allied Healthcare Providers claims in multiple states. You will be recognized as a technical expert in the interpretation of complex or unusual policy coverages. Under general management direction, you will work within defined authority limits, to manage professional liability healthcare claims with moderate to high complexity and exposure in accordance with company protocols, quality and customer service standards. You will also partner with internal business partners such as Underwriting, to share claim insights that aid in good underwriting decisions.

The individual will work with insureds, attorneys, other insurers and account representatives regarding the handling and/or disposition of complex litigated and non-litigated claims in multi-state jurisdictions. The individual will investigate and resolve claims, coordinate discovery and team with defense counsel on litigation strategy. They should be able to utilize claims policies and guidelines, review coverage, determine liability and damages, set financial reserves, secure information to negotiate and settle claims.

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

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 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 District of Columbia, California, Colorado, Connecticut, Maryland, New York and Washington, the national base pay range for this job level is $49,000 to $98,000 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 leaveadministration@cna.com.