Workers Compensation Claims Specialist, West

CNA Insurance; Brea (CA); Híbrido; USD 54 000 - 103 000; Tempo integral

Resumo da oferta

CNA Insurance in California is seeking an experienced Long Term Care claims professional to join our team under technical direction. You will review coverages, determine liability, and negotiate settlements while coordinating with attorneys, insureds and partners.

The role requires 3–5 years of claims experience, California experience or certification, and the ability to manage complex investigations. This hybrid position offers competitive pay and a comprehensive benefits package.

Qualificações

• Bachelor’s degree or equivalent experience.
• Typically 3–5 years claims experience.
• California experience and California certification preferred.

Responsabilidades

• Interprets more complex policy coverages and determines applicability; escalates issues as needed.
• Sets activities, reserves and authorizes payments within scope of authority; manages disbursements and costs.
• Coordinates investigations and evaluates claims with insureds, claimants, partners, witnesses and experts; seeks early resolution; refers potential fraud to SIU.
• Uses negotiation skills to develop complex settlement packages.
• Identifies third party recovery potential and coordinates with subrogation/salvage unit.
• Partners with attorneys, account representatives, underwriters, doctors and insureds to develop focused strategy for timely resolution.
• Analyzes claims activities and prepares reports for management; may handle special projects.
• Inputs data reflecting claim circumstances accurately.
• Provides guidance to other claims staff as needed.
• Keeps current on state regulations and industry trends.

Conhecimentos

Negotiation skills

Communication

Analytical thinking

Time management

Independent judgment

MS Office

General claims knowledge

Formação académica

Bachelor’s degree or equivalent experience

California experience and California certification preferred

Ferramentas

Microsoft Office Suite

Descrição da oferta de emprego

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.

Under technical direction, investigates and maintains Long Term Care claims. Works within specific limits of authority on assignments of significant technical complexity and coordination. Utilizing claims policies and guidelines, reviews coverages, determines liability and compensability, secures information, and negotiates and settles claims.

Essential Duties & Responsibilities

Performs a combination of duties in accordance with departmental guidelines:

• Interprets more complex or unusual policy coverages and determines if coverages apply to claims submitted, escalating issues as needed.
• Sets activities, reserves and authorizes payments within scope of authority. Ensures issuance of disbursements while managing loss costs and expenses.
• Coordinates and performs investigations and evaluates claims and suits through contact with insureds, claimants, business partners, witnesses and experts. Seeks early resolution opportunities. Identifies files that have potential fraud and refers to SIU.
• Utilizes negotiation skills to develop complex settlement packages.
• Identifies claims with third party recovery potential and coordinates with subrogation/salvage unit.
• Partners with attorneys, account representatives, agents, underwriters, doctors, nurse case managers and insureds to develop a focused strategy for timely and cost effective resolution of more complex claims.
• Analyzes claims activities. Prepares and presents reports for management. May be responsible for special projects and presentations.
• Responsible for input of data that accurately reflects claim circumstances and other information important to our business outcomes.
• May provide guidance and assistance to other claims staff and functional areas.
• Keeps current on state/territory regulations and issues as well as industry activity and trends.

May perform additional duties as assigned.

Reporting Relationship

Typically Manager or above

Skills, Knowledge & Abilities

• Solid knowledge of claims and insurance industry theory and practices.
• Demonstrated technical expertise and product specific knowledge.
• Strong interpersonal, communication and negotiation skills. Ability to effectively interact with all levels of CNA’s internal and external business partners.
• Ability to work independently, managing time and resources to accomplish multiple tasks and meet deadlines.
• Strong analytical and problem solving skills enabling viable alternative solutions.
• Ability to exercise independent judgement and make critical business decisions effectively assessing the merits of claims as well as evaluating claims based on a cost benefit analysis.
• Solid knowledge of Microsoft Office Suite as well as other business-related software.
• Ability to adapt to change and value diverse opinions and ideas.
• Ability to fully comprehend claim information; and to further articulate analyses of claims in internal reports.
• Ability to handle claims with a proactive long-term view of business goals and objectives.

Education & Experience

• Bachelor’s degree or equivalent experience. Professional designations preferred.
• Typically a minimum three to five years claims experience.
• California experience and California certified preferred. If not certified, willing to complete certification within first month of hire.

#LI-KP1

#LI-Hybrid

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 $54,000 to $103,000 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 visitcareers page.

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