Complex Claims Consultant Healthcare Medical Malpractice

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Due to an internal promotion CNA Insurance is searching for a Complex Claims Consultant focused on Allied Healthcare Providers / Medical Malpractice. 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.

In this position you will be responsible for the overall investigation management and resolution of Allied Healthcare Provider claims in multiple states within your assigned jurisdiction including matters involving nurses therapists counselors or other healthcare provider or facility insureds. Recognized as a technical expert in the interpretation of complex or unusual policy coverages you will work with autonomy and broad 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.

This role collaborates 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. You will investigate and resolve claims coordinate discovery and team with defense counsel on litigation strategy. You will 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 highly complex commercial claims with large exposures that require a high degree of specialized technical expertise and coordination by following company protocols to verify policy coverage conduct investigations develop and employ resolution strategies and authorize disbursements within authority limits.
• Ensures exceptional customer service by managing all aspects of the claim interacting professionally and effectively achieving quality and cycle time standards providing 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 companys claim handling protocols.
• Leads focused investigation to determine compensability liability and covered damages by gathering pertinent information such as contracts or other documents taking recorded statements from customers claimants injured workers witnesses and working with experts or other parties as necessary to verify the facts of the claim.
• Resolves claims by collaborating with internal and external business partners to develop own and execute a claim resolution strategy that includes management of timely and adequate reserves collaborating with coverage experts negotiating complex settlements partnering with counsel to manage complex litigation and authorizing payments within scope of authority.
• Establishes and manages claim budgets by achieving timely claim resolution selecting and actively overseeing appropriate resources authorizing expense payments and delivering high quality service in an efficient manner.
• Realizes and addresses subrogation / salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Claim Recovery or SIU resources for further investigation.
• Achieves quality standards by appropriately managing each claim to ensure that all company protocols are followed work is accurate and timely all files are properly documented and claims are resolved and paid timely.
• Keeps senior leadership informed of significant risks and losses by completing loss summaries identifying claims to include on oversight / watch lists and preparing and presenting succinct summaries to senior management.
• Maintains subject matter expertise and ensures compliance with state / local regulatory requirements by following company guidelines and staying current on commercial insurance laws regulations or trends for line of business.
• Mentors guides develops and delivers training to less experienced Claim Professionals.

May perform additional duties as assigned.

Reporting Relationship

Typically Director or above

Skills Knowledge & Abilities

Education & Experience

#LI-KP1

#LI-Hybrid

In Chicago / New York / California the average base pay range for the Complex Claims Consultant role is $113000 to $160000. Salary determinations are based on various factors including but not limited to relevant work experience skills certifications and location.

I n certain jurisdictions CNA is legally required to include a reasonable estimate of the compensation for this District of Columbia California Colorado Connecticut Illinois Maryland Massachusetts New York and Washington the national base pay range for this job level is $72000 to $141000 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 CNAs benefits please visit .

CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation please contact .

Required Experience :

Contract

Key Skills

Civil,Apparel,Banking,CMS,Infection Control

Employment Type : Full-Time

Experience : years

Vacancy : 1

Monthly Salary Salary : 113000 - 160000