Complex Claims Consultant, Medical Malpractice

CNA Insurance • Downers Grove, IL

1d • $116,000 - $165,000 • Hybrid

About The Position

This role supports the business and interacts with key customers in the Allied Healthcare Providers sector. As a Complex Claims Consultant focused on Medical Malpractice, you will be responsible for the overall investigation, management, and resolution of Allied Healthcare Provider claims across multiple states. You will act as a technical expert in interpreting complex policy coverages, managing professional liability healthcare claims with moderate to high complexity and exposure, and adhering to company protocols, quality, and customer service standards. You will also collaborate with internal departments like Underwriting to share claims insights and with insureds, attorneys, and other insurers regarding claim handling. Your responsibilities include investigating and resolving claims, coordinating discovery, partnering with defense counsel on litigation strategy, reviewing coverage, determining liability and damages, setting reserves, and negotiating settlements. This position offers a flexible, hybrid work schedule and can be based in one of the listed CNA office locations.

Requirements

• Bachelor's Degree or equivalent experience.
• Typically a minimum of six years of relevant experience, preferably in claim handling or medical malpractice litigation.
• Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.
• Prior negotiation experience.
• Thorough knowledge of the commercial 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 and ability to make sound business decisions.
• Ability to effectively evaluate and resolve ambiguous, complex, and challenging business problems.
• 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 commercial 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.
• Demonstrated ability to value diverse opinions and ideas.

Nice To Haves

• JD a plus.
• Professional designations preferred (e.g. CPCU).

Responsibilities

• Manages an inventory of highly complex commercial claims with large exposures requiring specialized technical expertise and coordination.
• Verifies policy coverage, conducts investigations, develops and employs resolution strategies, and authorizes disbursements within authority limits.
• Ensures exceptional customer service by managing all aspects of the claim, interacting professionally, achieving quality and cycle time standards, and providing timely updates.
• Verifies coverage and establishes timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel.
• Leads focused investigation to determine compensability, liability, and covered damages by gathering pertinent information, taking recorded statements, and working with experts.
• Resolves claims by collaborating with internal and external business partners to develop and execute a claim resolution strategy, including managing reserves, negotiating settlements, and managing litigation.
• Establishes and manages claim budgets by achieving timely claim resolution, selecting and overseeing appropriate resources, and authorizing expense payments.
• Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences.
• Achieves quality standards by ensuring company protocols are followed, work is accurate and timely, files are properly documented, and claims are resolved and paid promptly.
• Keeps senior leadership informed of significant risks and losses by completing loss summaries and preparing succinct summaries for senior management.
• Maintains subject matter expertise and ensures compliance with state/local regulatory requirements by following company guidelines and staying current on insurance laws and regulations.
• Mentors, guides, develops, and delivers training to less experienced Claim Professionals.
• May perform additional duties as assigned.

Benefits

• Comprehensive and competitive benefits package to help employees and their family members achieve their physical, financial, emotional and social wellbeing goals.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree