Complex Claims Consultant - Dental Healthcare

CNA Financial-posted about 2 months ago
$113,000 - $160,000/Yr
Full-time • Mid Level
Hybrid • Radnor, PA
5,001-10,000 employees
Insurance Carriers and Related Activities
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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, including dentists, physicians, nurses, nurse practitioners, physical therapists, counselors, pharmacists, massage therapists and more than 100 other categories of medical service providers, along with the facilities and practices in which they work. 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.

  • Manages an inventory of highly complex healthcare professional liability claims, with large exposures that require a high degree of specialized technical expertise and coordination.
  • Ensures exceptional customer service by managing all aspects of the claim, interacting professionally and effectively.
  • Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language.
  • Leads focused investigation to determine compensability, liability and covered damages.
  • Resolves claims by collaborating with internal and external business partners to develop, own and execute a claim resolution strategy.
  • Establishes and manages claim budgets by achieving timely claim resolution.
  • Realizes and addresses subrogation/salvage opportunities or potential fraud occurrences.
  • Achieves quality standards by appropriately managing each claim to ensure that all company protocols are followed.
  • Keeps leadership informed of significant risks and losses by completing loss summaries.
  • Maintains subject matter expertise and ensures compliance with state/local regulatory requirements.
  • Mentors, guides, develops and delivers training to less experienced Claim Professionals.
  • Thorough knowledge of the professional liability insurance industry, products, policy language, coverage, and claim practices.
  • Strong communication and presentation skills both verbal and written.
  • Demonstrated analytical and investigative mindset with critical thinking skills.
  • Strong work ethic, with demonstrated time management and organizational skills.
  • Ability to work in a fast-paced environment at high levels of productivity.
  • Demonstrated ability to negotiate complex settlements.
  • Experience interpreting complex insurance policies and coverage.
  • Ability to manage multiple and shifting priorities in a fast-paced and challenging environment.
  • Knowledge of Microsoft Office Suite and ability to learn business-related software.
  • A commitment to collaboration and demonstrated ability to value diverse opinions and ideas.
  • JD a plus.
  • Professional designations are a plus (e.g. CPCU).
  • Comprehensive and competitive benefits package to help employees and their family members achieve their physical, financial, emotional and social wellbeing goals.
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