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
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  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 leaveadministration@cna.com . 0:00 -/ - 1:56 Similar Jobs (2) Complex Claims Consultant - Healthcare Severity locations 11 Locations time type Full time posted on Posted 30+ Days Ago Complex Claims Consultant - Financial Institutions D&O/E&O and Public D&O locations 9 Locations time type Full time posted on 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