Complex Claims Specialist

15 hours ago

Portland OR United States CNA Insurance Full time

You have a clear vision of where your career can go. And we have the leadership to help you get there. At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.

CNA is the market leader in providing Lawyers liability coverage and provides best-in-class claim service. We are seeking a dynamic self-starter to join our team as a Complex Claims Specialist handling claims for law firms with less than 35 attorneys. At CNA, Claim Professionals use their specialized expertise to handle claims efficiently in a collaborative environment focused on continuous improvement.

The Complex Claims Specialist plays a critical role in managing and resolving legal malpractice claims by evaluating coverage, assessing liability and damages, setting timely reserves, negotiating and settling claims, and directing litigation. The Complex Claims Specialist will collaborate in a highly-experienced and rich team environment including claim leadership and business partners to ensure the best possible outcome on every claim. The Complex Claims Specialist will handle claims nationally under primary policies. They will be recognized as a technical expert in the interpretation of complex or unusual policy coverages in their area of expertise. Under general management direction, they will work within assigned limits of broad authority on assignments requiring a high degree of technical complexity and coordination. They handle approximately 150 pending Program Law claims.

We are currently operating on a hybrid schedule and are open to all CNA office locations with a preference for Chicago, IL, Tarrytown, NY, Louisville, KY.

JOB DESCRIPTION:

Essential Duties & Responsibilities:

Performs a combination of duties in accordance with departmental guidelines:

  • Manages an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, draft coverage letters, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits.
  • Provides exceptional customer service by establishing relationships and interacting professionally and effectively with insureds, claimants, defense counsel, and internal and external business partners, providing regular, timely updates and responding promptly to inquiries and requests for information.
  • Verifies coverage by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters and drafts coverage letters.
  • Conducts focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking statements from customers, claimants, injured workers, witnesses, and working with experts, defense counsel, or other parties, as necessary to verify the facts of the claim.
  • Establishes timely and adequate reserves by estimating potential claim valuation based on focused investigation and in accordance with company's claim handling protocols.
  • Authorizes and ensures claim disbursements within authority limit by determining liability and compensability of the claim, negotiating settlements and escalating to manager as appropriate.
  • Contributes to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources such as our leading panel of defense attorneys or experts, and delivering high quality service.
  • Identifies and addresses subrogation/recovery opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate internal Recovery or Special Investigations Unit resources for further investigation.
  • Achieves quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation and issuing appropriate claim disbursements.
  • Maintains compliance with state/local regulatory requirements by following company guidelines, and staying current on commercial insurance laws, regulations or trends for line of business.
  • May serve as a mentor/coach to less experienced claim professionals.

May perform additional duties as assigned.

Reporting Relationship

  • Typically Manager or above.

Skills, Knowledge & Abilities

  • Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices, based on either direct claim handling experience or experience at law firms that defend insurance industry clients.
  • Strong verbal and written communication skills with the ability to develop positive working relationships, summarize and present information to customers, claimants and senior management as needed.
  • Demonstrated ability to develop collaborative business relationships with internal and external work partners.
  • Ability to exercise independent judgement, solve moderately complex problems and make sound business decisions.
  • Demonstrated investigative experience with an analytical mindset and critical thinking skills.
  • Strong work ethic, with demonstrated time management and organizational skills.
  • Demonstrated ability to manage multiple priorities in a fast-paced, collaborative environment at high levels of productivity.
  • Developing ability to negotiate low to moderately complex settlements.
  • Adaptable to a changing environment.
  • Knowledge of Microsoft Office Suite and ability to learn business-related software.
  • Demonstrated ability to value diverse opinions and ideas.

Education & Experience:

  • Bachelor's Degree or equivalent experience. JD preferred.
  • Typically a minimum four years of relevant experience, preferably in claim handling or the defense of professionals.
  • Candidates who have successfully completed the CNA Claim Training Program may be considered after 2 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.
  • Professional designations are a plus (e.g. CPCU).
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