Complex Claims Consultant - Hospitals, Allied Facilities, Physicians
Company: CNA
Location: Chicago
Posted on: March 20, 2023
Job Description:
Complex Claims Consultant - Hospitals, Allied Facilities,
Physicians page is loaded Complex Claims Consultant - Hospitals,
Allied Facilities, Physicians Apply locations Chicago, IL, USA
Wyomissing, PA, USA Lisle, IL, USA Brea, CA, USA Glastonbury, CT,
USA time type Full time posted on Posted 3 Days Ago job requisition
id R-1976 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. - Healthcare Claims is recruiting
for a Complex Claims Consultant to work with our Healthcare
Professional Liability team. This individual contributor role will
work with our HAP (Hospitals Allied Facilities and Physicians)
segment.
This individual will work 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 healthcare providers
and this role will support the business and interact with these key
customers.
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 a solid background 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. This job involves approximately 10%
travel.JOB DESCRIPTION:Essential Duties & ResponsibilitiesPerforms
a combination of duties in accordance with departmental
guidelines:
- Manages an inventory of highly complex Healthcare 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 company's claim handling
protocols.
- Leads focused investigation to evaluate liability and covered
damages through communications with insureds, defense counsel,
claimants, claimants' counsel, business partners, witnesses, and
experts.
- 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 RelationshipTypically Manager or above
-
Skills, Knowledge & Abilities
- Thorough knowledge of the Healthcare insurance industry,
products, policy language, coverage, and claim practices.
- Strong communication and presentation skills both verbal and
written, including the ability to communicate business and
technical information clearly.
- Demonstrated analytical and investigative mindset with critical
thinking skills and ability to make sound business decisions, and
to effectively evaluate and resolve ambiguous, complex and
challenging business problems.
- Strong work ethic, with demonstrated 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 Healthcare insurance policies
and coverage. -
- Ability to manage multiple and shifting priorities in a
fast-paced and challenging 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 six years of relevant experience,
preferably in claim handling or equivalent legal experience
- Candidates with prior claims experience preferred
- Must have or be able to obtain and maintain an Insurance
Adjuster License within 90 days of hire, where applicable
- Prior negotiation experience#LI-MM1#LI-HybridIn 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 $56,000 to $223,850 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
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Posted 30+ Days Ago About Us At CNA, we are focused on success,
individually and collectively. We pride ourselves on promoting a
culture that challenges and engages people. We strive to connect
people, departments and business areas, to function as a team, and
to serve our customers and communities with professionalism and
respect.Our dedication to employee engagement, continuous learning
and the open exchange of ideas is the cornerstone of our business.
These ideals, combined with our focus on the customer, enable us to
explore new market opportunities and build on our success.Our
values, culture and financial strength are what differentiates us
from other employers and make CNA the place you want to work.
Diversity, Equity & Inclusion CNA is committed to fostering a
diverse and inclusive culture grounded in equity that supports our
organization, clients, and communities by prioritizing talent and
programs that represent our current environment and empower all
employees and partners to be active allies and advocates for
equality. Globally, our Employee Resource Groups - Advocacy for
Visible & Invisible Disabilities (AVID), Asian Professionals for
Excellence (APEX), Empowering Black Professionals (EBP),
Generational Perspectives (GP), Organization of Hispanics and
Latine Americanos ( -OHLA!), Pride, Women Impacting Leadership
(WIL) and Veterans - make CNA, and our communities, even stronger.
Corporate Social Responsibility At CNA, we have a long standing
commitment to the diverse communities in which we live and work. We
actively make a difference for the greater good through
partnerships, sustainability, initiatives, and working together for
a better tomorrow. Corporate Social Responsibility is not one
person, or one department, it's the entire enterprise coming
together to make the world a better place.
Keywords: CNA, Chicago , Complex Claims Consultant - Hospitals, Allied Facilities, Physicians, Healthcare , Chicago, Illinois
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