Complex Claims Consultant - Dental Healthcare

Complex Claims Consultant In Healthcare

Start the next chapter of your career as a Complex Claims Consultant in Healthcare for CNA Insurance. CNA is a market leader in insuring healthcare providers and facilities. This role will support the Healthcare business and interact with these key customers. You will be responsible for the overall investigation, management and resolution of Healthcare professional liability claims in multiple states. You will be recognized as a technical expert in the interpretation of complex or unusual policy coverages. Under general management direction, you will work within defined 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 and Risk Control, to share claim insights that aid in good underwriting and risk management decisions. The individual will work 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. The individual will investigate and resolve claims, coordinate discovery and team with defense counsel on litigation strategy. They should be able to 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 is available in any location near a CNA office.

Essential Duties & Responsibilities

• Manages an inventory of highly complex healthcare professional liability 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, estimating potential claim valuation, working with counsel and following the 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, 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 where necessary, 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 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.

Reporting Relationship

Typically Director or above

Skills, Knowledge & Abilities

Education & Experience :