Complex Claims Representative - Healthcare

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CNA's Specialty Healthcare Team is currently recruiting for a Complex Claim Representative to handle lower exposure matters. Under technical direction, the Complex Claim Representative will handle primarily pre-claims, subpoena assistance and licensing proceedings for multiple states, with the potential to grow into handling actual claims of low exposure if interest and technical proficiency are demonstrated. Duties will include investigation of submitted matters, direction and supervision of defense counsel, and communication with insureds. This role also may include providing assistance to teams handling higher exposure claims through building of insurance policy materials for coverage review; performance of tasks related to tracking of satisfaction of deductible and/or self insured retention obligations; and/or other special projects.
The individual will work within limited limits of authority on assignments requiring lower to moderate technical complexity and coordination. Individual should be able to utilize claims policies and guidelines, provide direct coverage information to insureds, draft coverage letters, investigate incidents, retain and direct defense counsel to assist with investigation/process as warranted.
JOB DESCRIPTION:
Essential Duties & Responsibilities:
Performs a combination of duties in accordance with departmental guidelines:

• Manages an inventory of low to moderate complexity and exposure commercial claims by following company protocols to verify policy coverage, gather necessary information, maintain appropriate file documentation and authorize disbursements within authority limit.
• Contributes to customer satisfaction by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, 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, estimating potential claim valuation, and following company's claim handling protocols.
• Exercises judgment to determine liability and compensability by conducting investigations to gather pertinent information, taking recorded statements from insureds, witnesses and working with experts to verify the facts of the claim.
• Works with appropriate internal and external partners, suppliers and experts by identifying and effectively collaborating with necessary resources to facilitate best claim outcomes.
• Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate.
• Developing ability to manage expenses by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high quality service.
• Identifies 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 on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements.
• Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business.

May perform additional duties as assigned.
Reporting Relationship
Typically Manager or above
Skills, Knowledge & Abilities

• Developing basic knowledge of the commercial insurance industry, products and claim practices.
• Good verbal and written communication skills with the ability to demonstrate empathy while providing exceptional customer service.
• Ability to develop collaborative business relationships with both internal and external work partners.
• Able to exercise independent judgement, solve basic problems and make sound business decisions.
• Analytical mindset with critical thinking skills.
• Strong work ethic, with demonstrated time management and organizational skills.
• Ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity.
• Knowledge of Microsoft Office Suite and ability to learn business-related software.
• Adaptable to a changing environment
• Ability to value diverse opinions and ideas

Education & Experience:

• High school Diploma required. Associates or Bachelor's Degree preferred.
• Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.
• Prior claim handling, or business experience in the insurance industry and/or customer service is preferred.

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I n certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia , California, Colorado, Connecticut, Maryland , New York and Washington, the national base pay range for this job level is $44,000 to $74,000 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 is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact [email protected] .