Claim Quality Review Consultant

4 weeks ago

Wyomissing, 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.

Under technical direction, conducts on-site Claim audits, monitors compliance and controls, ensures adherence to Claims Best Practices; consistency, timeliness, and accuracy of eligibility decisions; and high levels of customer service. Reviews and makes recommendations regarding claim decision processes and outcomes. Assists in the selection, design and implementation of system enhancements associated with claim decision and integration of processes to improve claim outcomes.

JOB DESCRIPTION:
Essential Duties & Responsibilities
- Performs a combination of duties in accordance with departmental guidelines:_

Conduct Quality Assurance post-decision audits of insurance claims, in accordance with established strategies and objectives, focusing on:

- Decision accuracy consistency and timeliness
- Risk mitigation
- Adherence to guidelines and operating procedures
- Alignment with best practices

Supports senior leadership in the identification of claim trends and opportunities for continuous process improvement. Conducts pre-review of Claim decisions which may include high dollar claim payments and proposed denials.

Participate as needed in response to appeals, escalations, and complaints. Drafts guidelines and implements changes to business processes, workflows, and practices to ensure alignment with CNA expectations.

Supports regulatory changes and impact to operations.

Supports market conduct exams and DOI audits.

Supports local training needs in conjunction with overall Claim objectives; facilitate and conduct common training as needed.

Drafts Claim reporting and dashboards as needed.

Participates with senior leadership in the development and implementation of Claim policies, business strategies, metrics and goals; regularly evaluates performance against goals, and holds self-accountable for achieving desired results.

May perform additional duties as assigned.

Reporting Relationship

Typically Manager or above

Skills, Knowledge & Abilities

Working knowledge of claim auditing and assigned line of business. Has the ability to analyze, interpret, and present complex problems and solutions to a variety of audiences.

Ability to effectively interact and collaborate with all levels of CNA's internal and external business partners, possessing strong communication and presentation skills.

Strong analytical, critical thinking and problem solving skills, with the ability to effectively plan and manage multiple projects and project work teams with an eye for Claim innovation.

Ability to identify Claim opportunities, evaluate options, and recommend optimal solutions.

Prioritizes Claim opportunities and achieves results by taking a proactive, long term view of business goals and objectives.

Ability to understand business needs and think through all scenarios and challenges before formulating potential solutions.

Ability to solve problems with a sense of urgency; able to utilize and manage all available resources to make informed decisions and achieve superior results.

Demonstrates the knowledge and understanding of when and how to use Claim data and metrics to assist in making informed business decisions.

Exercises professional judgment and assumes responsibility for decisions that impact people and quality of service.

Ability to creatively and effectively manage through ambiguous and challenging business problems and lead through change while taking appropriate level of risk.

Education & Experience

Bachelor's Degree or equivalent work experience

Typically a minimum of five years of related work experience.

LI-AR1

LI-Hybrid
- In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In California, Colorado, Connecticut, New York and Washington, the national base pay range for this job level is $49,000 to $98,000 _annually. 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. For a detailed look at CNA’s benefits, please visit _
- ._

CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact

.

  • General Liability Claims Consultant

    2 weeks ago

    Wyomissing, 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. This individual contributor position works under general direction, and...

  • Workers Compensation Claims Consultant

    3 weeks ago

    Wyomissing, United States CNA Full time

    JOB DESCRIPTION : Essential Duties & Responsibilities Performs a combination of duties in accordance with departmental guidelines: Manages highly complex investigations of claims, including coverage issues, liability, compensability and damages. Determines if a major claim should be settled or litigated and implements an appropriate resolution strategy...

  • Complex Claims Consultant

    5 days ago

    Wyomissing, United States Istituto Marangoni 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. This individual contributor position works under general direction, and...

  • Claims Representative, APD

    6 days ago

    Wyomissing, United States CNA Full time

    JOB DESCRIPTION : Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: Manages an inventory of low to moderate complexity and exposure commercial claims by following company protocols to verify policy coverage, gather necessary information, maintain appropriate file documentation and...

  • Complex Claims Specialist

    2 weeks ago

    Wyomissing, United States CNA Full time

    JOB DESCRIPTION : Essential Duties & Responsibilities: Performs a combination of duties in accordance with departmental guidelines: Manages an inventory of low to moderate complexity and exposure commercial claims by following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize...

  • Work Comp

    2 weeks ago

    Wyomissing, United States The Travelers Companies, Inc. Full time

    Who Are We? - Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 160 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving...

  • Epic Hospital Billing Claims Analyst

    4 weeks ago

    Wyomissing, United States Tower Health Full time

    **Responsibilities**: **Are you an experienced Epic HB Claims Analyst?** Reporting to an Applications Manager, you will be a key player in supporting Epic at Tower Health as analyst. As a member of the Epic team, your contributions will involve: - Implementing, developing and maintaining the Epic system along with associated third party systems by...

  • Svcs/Operations Manager, Claim Operations

    4 weeks ago

    Wyomissing, United States CNA Full time

    JOB DESCRIPTION : Essential Duties & Responsibilities Performs a combination of duties in accordance with departmental guidelines: Assigns, distributes and coordinates work of the team with other teams ensuring consistent, efficient and timely delivery of service to drive superior results. Validates staffing levels and anticipates workforce demands....

  • Provider Services Associate

    4 weeks ago

    Wyomissing, United States The Loomis Company Full time

    The Loomis Company is seeking individuals who are driven, reliable, and looking to excel with our growing team! For over 65 years, The Loomis Company has been a family owned company committed to protecting what you value most Your people. Your assets. Your future. **WHO WE ARE**: With a reputation as one of the most trusted insurance experts in the...

  • Medical Billing

    1 month ago

    Wyomissing, United States PeopleShare Full time

    We are seeking a highly motivated and detail-oriented individual to join our medical billing client as a Medical Billing Specialist. You will be responsible for various aspects of medical billing and revenue cycle management. The ideal candidate will possess strong communication skills, attention to detail, and the ability to work efficiently in a fast-paced...

  • Senior Civil Engineer

    1 month ago

    Wyomissing, United States MCCARTHY ENGINEERING ASSOCIATES INC Full time

    Job DescriptionJob DescriptionSummary/ObjectiveThe Senior Project Engineer-Civil is responsible for the design of erosion & sedimentation control plans, floodplain analysis, storm water management, best management practices, site layout, storm/sanitary sewer/water utility design, and grading. They will also be responsible for completing calculations,...

  • Core Business Unit

    3 weeks ago

    Wyomissing, United States Tompkins Community Bank Full time

    Overview: Responsible for cultivating, growing and maintaining small business accounts and relationships consistent with Tompkins Insurance strategies. provide assistance to the Core Business Unit (CBU) Team Leader with handling and processing of new and renewal commercial business, meet with insurance company representatives such as automation specialists,...

  • Restaurant Manager | Fresh Food, Quality of Life Leader | Wyomissing, PA

    1 month ago

    Wyomissing, United States Gecko Hospitality Full time

    Fast Casual Restaurant ManagerSalary $55-60k Benefits and Bonus PotentialClosed Holidays, No Late Nights! Wyomissing, PA Our company is searching for an organized Restaurant Manager who can lead a team of professionals to success! If this sounds like the career you are looking for, apply today as a Restaurant Manager at our new location in Wyomissing, PA....

  • Commercial Lines Account Manager

    2 months ago

    Wyomissing, United States Element Risk Full time

    : The Commercial Account Manager is responsible for managing and servicing an assigned book of business, by analyzing customers’ individual needs, evaluating options, and offering tailored insurance solutions. The Commercial Account Manager is responsible to build and sustain relationships with existing customers and to promote the agency. The primary line...

  • Advisor

    3 weeks ago

    Wyomissing, United States Element Risk Full time

    POSITION: Advisor DIVISION: Region 2 REPORTS TO: Max George, Regional Manager, Element Risk Management LICENSE REQUIRED: Yes (P&C) STATUS: Exempt : The Advisor is responsible for developing and managing a book of business. The Advisor also needs to service insurance customers by analyzing their individual needs, evaluating options, and offering tailored...

  • Collections Specialist

    1 month ago

    Wyomissing, United States The Reserves Network Inc Full time

    Job DescriptionJob DescriptionYour New Organization: Looking to build your career in an exciting industry and a growing world class organization? They are the largest pest control company in the world, and they are looking to add a collections specialist to their team. They pride themselves on being a trusted partner to many of the world's leading brands...

  • Commercial Banking Team Leader

    2 weeks ago

    Wyomissing, United States F.N.B. Corporation Full time

    Position Overview: This position is primarily responsible for establishing banking relationships with middle market and large corporate customers in and around the region and for the management of a commercial banking team. The incumbent supervises and develops the commercial banking team to maintain and grow the loan portfolio and to develop and...

  • Senior Project Engineer

    1 month ago

    Wyomissing, United States Signature Staffing Full time

    Job Description Job Description Signature Staffing, a distinguished full-service staffing and employment agency located in central Pennsylvania, is currently assisting a highly esteemed and successful engineering firm in the Reading, PA region with their search for a Senior Project Electrical Engineer. With a remarkable 24-year history of excellence and a...

  • Senior Project Engineer

    1 month ago

    Wyomissing, United States Signature Staffing Full time

    Job DescriptionJob DescriptionSignature Staffing, a distinguished full-service staffing and employment agency located in central Pennsylvania, is currently assisting a highly esteemed and successful engineering firm in the Reading, PA region with their search for a Senior Project Electrical Engineer. With a remarkable 24-year history of excellence and a...

  • Surgery Center Administrator

    3 weeks ago

    Wyomissing, United States United Surgical Partners International Inc (USPI) Full time

    **Job Summary** - Responsible for directing, coordinating, and controlling all aspects of the operating functions, processes, and staff of the facility while demonstrating the primary goal of efficiently providing surgical services that exceed customer expectations and improve clinical and financial operations. **Responsibilities and Expectations** - The...