Complex Claims Consultant

1 day ago

Village of Tarrytown NY 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 Consultant. This Complex Claims Consultant will play a critical role in managing and resolving complex legal malpractice claims by evaluating coverage, assessing liability and damages, setting timely reserves, negotiating and settling claims, and directing litigation. At CNA, Claims Professionals use their specialized expertise to handle claims efficiently and seamlessly in a collaborative environment focused on continuous improvement. The individual in this role will collaborate in a rich team environment including claim leadership and business partners to ensure the best possible outcome on every claim.

Claims are handled on an account basis and involve primary, excess and quota share policies. Recognized as a technical expert in the interpretation of complex or unusual policy coverages in area of expertise. Under general management direction, works within assigned limits of broad authority on assignments requiring a high degree of technical complexity and coordination. May have regional, industry segment or company-wide scope of responsibility within specialty area. The claim professional will handle approximately 150 pending Program Law or Large Law claims.

JOB DESCRIPTION:

Essential Duties & Responsibilities

Performs a combination of duties in accordance with departmental guidelines:

  • 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.
  • Realizes 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.

May perform additional duties as assigned.

Reporting Relationship

Typically Director or above

Skills, Knowledge & Abilities

  • Thorough knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices.
  • Strong communication and presentation skills both verbal and written, including the ability to communicate business and technical information clearly.
  • Demonstrated analytical and investigative mindset with critical thinking skills and ability to make sound business decisions, and 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.

Education & Experience

  • Bachelor's Degree or equivalent experience. Juris Doctorate is strongly preferred.
  • Typically a minimum six years of relevant experience, preferably in claim handling.
  • Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.
  • Prior negotiation experience.
  • Professional designations preferred (e.g. CPCU).
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