Hybrid Complex Healthcare Claims Specialist

CNA Insurance; Irvine (CA); Hybrid; USD 72,000 - 141,000; Full time

Job summary

CNA Insurance is seeking a Complex Claims Consultant to support varying healthcare provider segments across multiple states. You will investigate, manage, and settle high-exposure professional liability claims with autonomy, coordinating with underwriting and defense counsel to determine coverage and reserves.

The role requires six years of relevant claims experience, an active Insurance Adjuster License (within 90 days), and professional designations such as CPCU are preferred.

Qualifications

• Bachelor's degree or equivalent experience is required.
• Typically a minimum six years of relevant claims experience.
• Must have or be able to obtain an Insurance Adjuster License within 90 days of hire.
• Professional designations such as CPCU are preferred.

Responsibilities

• Manages highly complex commercial claims with large exposure, following policy and company protocols.
• Provides exceptional customer service by timely updates and inquiries response.
• Verifies coverage and establishes reserves by interpreting policy language and involving coverage counsel.
• Leads investigations to determine compensability, liability, and damages with needed evidence and witnesses.
• Develops and executes claim resolution strategies with internal/external partners and negotiates settlements.
• Manages claim budgets and resources to deliver high-quality service efficiently.
• Identifies subrogation or fraud opportunities and refers for further action.
• Ensures compliance with regulatory requirements and maintains up-to-date expertise.

Skills

Complex claims handling

Analytical thinking

Negotiation

Communication skills

Time management

Multi-tasking

Education

Bachelor’s Degree or equivalent experience

Six years of relevant experience

Insurance Adjuster License within 90 days

CPCU or similar designation preferred

Tools

Microsoft Office Suite

Claims software

Job description

CNA Insurance is seeking a Complex Claims Consultant to support varying healthcare provider segments across multiple states. You will investigate, manage, and settle high-exposure professional liability claims with autonomy, coordinating with underwriting and defense counsel to determine coverage and reserves.

The role requires six years of relevant claims experience, an active Insurance Adjuster License (within 90 days), and professional designations such as CPCU are preferred.