Complex Claims Consultant - Healthcare Medical Malpractice

Complex Claims Consultant

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. Due to an internal promotion, CNA Insurance is searching for a Complex Claims Consultant focused on Allied Healthcare Providers / Medical Malpractice. CNA is a market leader in insuring Allied Healthcare Providers, including nurses, nurse practitioners, physical therapists, counselors, pharmacists, massage therapists and more than 100 other categories of medical service providers. This role will support the business and interact with these key customers. In this position you will be responsible for the overall investigation, management and resolution of Allied Healthcare Provider claims in multiple states within your assigned jurisdiction including matters involving nurses, therapists, counselors or other healthcare provider or facility insureds. Recognized as a technical expert in the interpretation of complex or unusual policy coverages, you will work with autonomy and broad 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, to share claim insights that aid in good underwriting decisions. This role collaborates 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. You will investigate and resolve claims, coordinate discovery and team with defense counsel on litigation strategy. You will 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 commercial 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 and partnering with coverage counsel on more complex matters, estimating potential claim valuation, and following 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, injured workers, 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, 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 senior 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