Workers Compensation Claims Specialist, Complex & Settlement Focus

CNA • Los Angeles, CA

10d • Hybrid

About The Position

This individual contributor works under moderate direction and within defined authority limits to manage commercial workers’ compensation claims with moderate to high complexity and exposure. The role investigates and resolves claims in accordance with company protocols, quality standards, and customer service standards, including California Stipulated and Future Medical claims. It emphasizes proactively identifying and advancing settlement opportunities. The position requires regular communication with customers and insureds and may be dedicated to specific accounts.

Requirements

• Bachelor’s degree or equivalent experience.
• Typically a minimum of four years of relevant experience, preferably in claim handling.
• Candidates who have successfully completed the CNA Claim Training Program may be considered with two years of claim-handling experience.
• Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.
• Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices.
• Solid verbal and written communication skills, including the ability to build positive working relationships and present information to customers, claimants, and senior management.
• Ability to develop collaborative business relationships with internal and external work partners.
• Ability to exercise independent judgment, solve moderately complex problems, and make sound business decisions.
• Demonstrated investigative experience, analytical mindset, and critical-thinking skills.
• Strong work ethic and demonstrated time-management and organizational skills.
• Ability to manage multiple priorities in a fast-paced, collaborative environment while maintaining high productivity.
• Developing ability to negotiate low- to moderately complex settlements.
• Adaptability to a changing environment.
• Knowledge of Microsoft Office Suite and ability to learn business-related software.
• Demonstrated ability to value diverse opinions and ideas.

Nice To Haves

• Professional designations, such as CPCU.

Responsibilities

• Manage an inventory of moderate- to high-complexity commercial claims by verifying policy coverage, conducting investigations, developing and applying resolution strategies, and authorizing disbursements within authority limits.
• Provide professional, effective customer service to insureds, claimants, and business partners; meet quality and cycle-time standards; provide timely updates; and respond promptly to inquiries and information requests.
• Verify coverage and establish timely, adequate reserves by interpreting policy language, partnering with coverage counsel on complex matters, estimating claim value, and following claim-handling protocols.
• Investigate compensability, liability, and covered damages by gathering relevant information and documents, taking recorded statements, and working with experts or other parties as needed.
• Build and maintain working relationships with internal and external partners, suppliers, and experts who can assist with claim resolution.
• Determine liability and compensability, negotiate settlements, authorize claim disbursements within authority limits, and escalate matters to a manager as appropriate.
• Contribute to expense management by resolving claims accurately and promptly, selecting and overseeing appropriate resources, and delivering high-quality service.
• Identify subrogation or salvage opportunities and potential fraud, evaluating claim facts and referring matters to Recovery or SIU resources as appropriate.
• Meet quality standards by following company guidelines, achieving quality and cycle-time targets, documenting files properly, and issuing appropriate claim disbursements.
• Maintain compliance with state and local regulatory requirements and stay current on relevant commercial insurance laws, regulations, and trends.
• May mentor or coach less experienced claim professionals.
• May perform additional duties as assigned.

Benefits

• Comprehensive and competitive benefits package intended to support employees’ and family members’ physical, financial, emotional, and social wellbeing.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level