Complex Claims Consultant, Aging Services

JOB DESCRIPTION Complex Claims Consultant – The Healthcare Claims team is seeking a Complex Claims Consultant to support the Aging Services segment. This individual contributor will manage, investigate, and resolve complex Aging Services claims in multiple states, acting as a technical expert on coverage interpretation and claim resolution. ESSENTIAL DUTIES & RESPONSIBILITIES Manage an inventory of highly complex specialty claims with large exposures, following company protocols to verify coverage, conduct investigations, develop resolution strategies, and authorize disbursements within authority limits. Provide exceptional customer service by managing all aspects of claims, interacting professionally, and meeting quality & cycle‑time standards. Verify coverage and establish reserves by reviewing policy language, partnering with coverage counsel, estimating potential claim valuation, and following claim handling protocols. Lead investigations to determine compensability and liability by gathering relevant documents, conducting statements, working with experts and other parties. Resolve claims by collaborating with partners to develop and execute resolution strategies, managing reserves, negotiating settlements, and authorizing payments within scope of authority. Establish and manage claim budgets, oversee resources, authorize expenses, and deliver quality service efficiently. Identify subrogation/salvage opportunities or fraud, make referrals to recovery teams. Maintain quality standards by ensuring accurate, timely documentation and payment. Inform senior leadership of significant risks and losses through loss summaries and watch lists. Maintain subject‑matter expertise and comply with state/local regulations. Mentor and train less experienced claim professionals. Perform additional duties as assigned. SKILLS, KNOWLEDGE & ABILITIES Thorough knowledge of commercial insurance industry, products, policy language, coverage, and claim practices. Strong verbal and written communication and presentation skills. Analytical and investigative mindset with critical thinking. Time management and organizational skills; ability to work in a fast‑paced environment. Negotiation skills and experience with complex settlements. Experience interpreting complex specialty policies. Ability to manage multiple priorities. Microsoft Office proficiency and ability to learn business software. Openness to diverse opinions and collaborative mindset. EDUCATION & EXPERIENCE Bachelor’s Degree or equivalent; JD a plus. Minimum six years relevant experience, preferably in claim handling and litigation. Prior negotiation experience. Must have or obtain an Insurance Adjuster License within 90 days of hire (where applicable). Professional designations preferred (e.g. CPCU). LOCATION & COMPENSATION Hybrid work schedule; location near a CNA office. In certain jurisdictions (DC, CA, CO, CT, IL, MD, MA, NY, WA), national base pay range $72,000–$141,000 annually. BENEFITS CNA offers a comprehensive benefits package that supports physical, financial, emotional, and social wellbeing. For a detailed look at benefits, visit cnabenefits.com. ACCOMMODATIONS We are committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. Contact View email address on click.appcast.io to request accommodations. #J-18808-Ljbffr 01460 Continental Casualty Company