Medical Claims Adjuster/ Processor

And we have the leadership to help you get there. 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 Medical Malpractice focused Complex Claims Consultant 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 work 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 can work from one of the listed CNA office locations.

JD --- This individual contributor position works under general direction, and within broad authority limits, to manage commercial claims with high complexity and exposure for a specialized line of business. Responsibilities include the coordination of all claim resolution activities in accordance with company protocols, while achieving quality and customer service standards. Position requires regular communication with customers and insureds and may have regional, industry segment or company‑wide scope of responsibility.

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.

Realises 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.

Thorough knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices.

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.

Bachelor's Degree or equivalent experience.

Typically a minimum 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.

In Chicago/New York/California, the average base pay range for the Complex Claims Consultant role is $116,000 to $165,000. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location.

Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location.

CNA offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional and social wellbeing goals. CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. J-18808-Ljbffr CNA Insurance