Complex Claims Consultant - Healthcare Medical Malpractice

CNA Insurance; Melville (NY); Hybrid; USD 72,000 - 141,000; Full time

Job summary

CNA Insurance in Melville, NY is seeking a Complex Claims Consultant to support Healthcare Claims for Allied Healthcare Providers, Aging Services and Dental Malpractice. You will investigate, manage and resolve highly complex claims across multiple states, interpreting policy coverages with autonomy and applying company guidelines.

The role offers a flexible, hybrid work schedule and collaboration with Underwriting and defense counsel.

Qualifications

• Bachelor's degree or equivalent experience required.
• Typically six years of relevant experience in claims or medical malpractice litigation.
• Must obtain an Insurance Adjuster License within 90 days, where applicable.
• Professional designations such as CPCU preferred.

Responsibilities

• Manage an inventory of highly complex commercial claims with large exposures.
• Provide exceptional customer service and timely updates.
• Verify coverage and establish reserves per policy language.
• Lead investigations to determine compensability and damages.
• Negotiate complex settlements with internal and external partners.
• Mentor and train less experienced claim professionals.

Skills

Communication skills

Analytical thinking

Negotiation

Time management

Multi-tasking

Problem solving

Attention to detail

Education

Bachelor's Degree or equivalent experience

Six years of relevant experience in claims or medical malpractice litigation

Insurance Adjuster License within 90 days

CPCU designation preferred

Tools

Microsoft Office Suite

Job description

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 healthcare providers and facilities, including nurses, nurse practitioners, aging services, dentists, 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.

Our Healthcare Claims team is seeking Complex Claims Consultants to support varying segments such as Allied Healthcare Providers & Facilities, Aging Services and/or Dental Malpractice. As a Complex Claims Consultant, you will be responsible for the overall investigation, management and resolution of claims in multiple states within your assigned jurisdiction including matters of different focus areas depending on the role available, that may involve nurses, therapists, counselors, dentists, aging services 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 can work from one of the listed CNA office locations.

Job Description

Essential Duties & Responsibilities

• 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 company's 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

• 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 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 commercial 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.
• Typically a minimum six years of relevant experience, preferably in claim handling or medical malpractice litigation.
• Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.
• Prior negotiation experience.
• Professional designations preferred (e.g. CPCU).

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, Illinois, Maryland, Massachusetts, New York and Washington, the national base pay range for this job level is $72,000 to $141,000 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 utilizes AI-enabled technology during the recruiting process. For more information, please visit our careers page.

CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact [e-mail]