Workers Compensation TPA Oversight Claims Consultant

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

Job summary

CNA Insurance is seeking an experienced individual contributor to provide technical oversight of complex, high-exposure workers' compensation claims handled by TPAs. The role involves guiding claim strategies, reserves, and resolution plans, and leading through influence with TPAs, clients, and internal partners.

Minimum eight years of claims experience and a Bachelor's degree are expected, with professional designation preferred.

Qualifications

• Advanced knowledge of claims principles and resolution strategies.
• Strong ability to analyze complex claims and present findings.
• Excellent negotiation and presentation skills.

Responsibilities

• Manages highly complex investigations of claims, including coverage issues, liability, compensability and damages.
• Determines settlement or litigation strategies and manages loss costs and expenses.
• Coordinates discovery and litigation strategy with counsel or panel attorneys.
• Negotiates complex settlement packages and authorizes payments within authority.
• Coordinates third-party recovery with subrogation unit.
• Provides input on claims processes and resolution strategies to management.
• Analyzes claims activity and prepares reports for stakeholders.
• Collaborates with attorneys, account representatives, agents, doctors and insureds.
• Stays current on state regulations and industry trends; may participate in trade groups.
• Mentors less experienced staff and supports other functions.

Skills

Advanced claims expertise

Communication

Negotiation

Analytical thinking

Influence through collaboration

Education

Bachelor's degree or equivalent experience

Professional designation preferred

Eight years of claims experience

Tools

Microsoft Office

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.
This individual contributor position works under general direction, and within broad authority limits, to provide technical oversight of complex, high-exposure commercial Workers' Compensation claims handled by Third-Party Administrators (TPAs). While not responsible for people management, the role functions as a subject matter leader, influencing claim outcomes through expertise, collaboration, and oversight.
The position is responsible for reviewing and guiding claim strategies, reserves, and resolution plans to ensure alignment with company protocols, regulatory requirements, and best practices. Success in this role requires the ability to lead through influence by setting expectations, partnering effectively with TPAs, clients, and internal stakeholders, and driving accountability for quality, compliance, and performance through consultative engagement and clear communication. The role may support designated accounts and requires regular interaction with internal and external partners to achieve optimal claim outcomes and customer service standards.

JOB DESCRIPTION:

Essential Duties & Responsibilities

Performs a combination of duties in accordance with departmental guidelines:

• Manages highly complex investigations of claims, including coverage issues, liability, compensability and damages. Determines if a major claim should be settled or litigated and implements an appropriate resolution strategy accordingly. Effectively manages loss costs and claim expenses.
• Manages all types of investigative activity or litigation on major claims, including the posting of appropriate reserves in a timely manner. Coordinates discovery and litigation strategy with staff counsel or panel attorneys.
• Negotiates highly complex settlement packages, and authorizes payment within scope of authority, settling claims in most cost effective manner and ensuring timely issuance of disbursements.
• Coordinates third party recovery with subrogation/salvage unit.
• Makes recommendations on claims processes and resolution strategies to management.
• Analyzes claims activities; prepares and presents reports to management and other internal business partners and clients.
• Works with attorneys, account representatives, agents, doctors and insureds regarding the handling and/or disposition of highly complex claims.
• Keeps current on state/territory regulations and issues, industry activity and trends. May participate in industry trade groups.
• Provides guidance and assistance to less experienced claims staff and other functional areas.
• Responsible for input of data that accurately reflects claim circumstances and other information important to our business outcomes.

Reporting Relationship

Manager or above.

Skills, Knowledge And Abilities

• Advanced technical and product specific expertise, claims resolution skill and knowledge of insurance and claims principles, practices and procedures.
• Strong communication, negotiation and presentation skills. Ability to effectively interact with all levels of CNA's internal and external business partners.
• Advanced analytical and problem solving skills, with the ability to manage and prioritize multiple projects.
• Ability to deal with ambiguous situations and issues.
• Creativity in resolving unique and challenging business problems.
• Knowledge of Microsoft Office Suite and other business-related software.
• Ability to adapt to change and value diverse opinions and ideas.
• Ability to manage and prioritize multiple projects.
• Ability to evaluate claims based on a cost benefit analysis.
• Ability to fully comprehend complex claim facts and issues; and to further articulate analyses of claims in presentations to business partners and management as well as in internal reports.
• Ability to implement strategies with a proactive long-term view of business goals and objectives.

Education And Experience

• Bachelor's degree or equivalent experience.
• Professional designation preferred.
• Typically a minimum eight years claims experience.

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]