Workers Compensation Claims Specialist
3 months ago
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 moderate direction, and within defined authority limits, to manage commercial claims with moderate to high complexity and exposure for a specific line of business. Responsibilities include investigating and resolving claims according to company protocols, quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s).
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, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits.
- Provides exceptional customer service by interacting professionally and effectively with insureds, claimants and business partners, achieving quality and cycle time standards, providing regular, 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.
- Conducts 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.
- Establishes and maintains working relationships with appropriate internal and external work partners, suppliers and experts by identifying and collaborating with resources that are needed to effectively resolve claims.
- 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, and delivering high quality service.
- Identifies and addresses subrogation/salvage opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate Recovery or SIU 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
Reporting Relationship
Typically Manager or above
Skills, Knowledge & Abilities
- Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices.
- Solid 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
- Bachelor's Degree or equivalent experience.
- Typically a minimum four years of relevant experience, preferably in claim handling.
- 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)
#LI-AR1
#LI-Hybrid
In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia, California, Colorado, Connecticut, Maryland, 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 cnabenefits.com.
CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact leaveadministration@cna.com.
-
Claims Adjuster
6 hours ago
Plano, Texas, United States Sedgwick Full timeJob SummaryWe are seeking a highly skilled and experienced Claims Adjuster - Workers Compensation Specialist to join our team at Sedgwick. As a key member of our claims management team, you will be responsible for analyzing and processing complex workers' compensation claims, ensuring timely and cost-effective resolution.Key ResponsibilitiesAnalyze and...
-
Claims Adjuster
2 weeks ago
Plano, United States Sedgwick Full timeClaims Adjuster - Workers Compensation page is loaded **Claims Adjuster - Workers Compensation** **Claims Adjuster - Workers Compensation** locationsPlano, TXTelecommuter TX time typeFull time posted onPosted Yesterday job requisition idR17462 **The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not...
-
Claims Adjuster
3 months ago
Plano, United States Sedgwick Full timeClaims Adjuster - Workers Compensation page is loaded **Claims Adjuster - Workers Compensation** **Claims Adjuster - Workers Compensation** locationsPlano, TXTelecommuter TX time typeFull time posted onPosted Yesterday job requisition idR17462 **The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not...
-
Claims Management Specialist II
2 weeks ago
Plano, Texas, United States Liberty Mutual Full timeCompensation Philosophy The starting salary range for this position is influenced by various factors such as skills, experience, education, certifications, and geographical location. The complete salary range reflects the competitive market value for all employees in similar roles across the national landscape and provides opportunities for advancement as...
-
Claims Management Specialist II
2 weeks ago
Plano, Texas, United States Liberty Mutual Group Full timePosition OverviewThe Claims Specialist II plays a crucial role in overseeing a portfolio of Workers' Compensation claims, including those pertaining to Texas Non-Subscriber cases. This position is essential for assessing the validity and liability of claims, ensuring that all processes align with established protocols and regulatory standards.Key...
-
Insurance Claims Evaluator II
2 weeks ago
Plano, Texas, United States Liberty Mutual Group Full timePosition OverviewThe Claims Specialist II plays a crucial role in overseeing a portfolio of Workers' Compensation claims, including those related to Texas Non-Subscriber cases. This position is responsible for assessing the validity and liability of claims, ensuring that all evaluations are thorough and accurate.Key ResponsibilitiesEvaluate and manage a...
-
Risk Management Claims Professional
5 days ago
Plano, Texas, United States Sedgwick Full timeJob SummaryWe are seeking a highly skilled and experienced Claims Adjuster - Workers Compensation Specialist to join our team at Sedgwick. As a key member of our claims management team, you will be responsible for analyzing and processing complex workers' compensation claims, ensuring timely and cost-effective resolution.Key ResponsibilitiesAnalyze and...
-
Commercial Claims Specialist
5 days ago
Plano, Texas, United States CNA Full timeJob SummaryCNA is seeking a highly skilled Commercial Claims Specialist to join our team. As a key member of our claims department, you will be responsible for managing commercial claims with moderate to high complexity and exposure.Key ResponsibilitiesClaim Management: Investigate and resolve claims according to company protocols, quality and customer...
-
Healthcare Claims Negotiation Specialist
2 weeks ago
Plano, Texas, United States The Reny Company Full timePosition: Healthcare Claims Negotiation SpecialistThe Reny Company is in search of a proficient Healthcare Claims Negotiation Specialist to enhance our team. Candidates with relevant qualifications and experience in medical claims negotiation are encouraged to consider this opportunity.Evaluate and negotiate reductions on out-of-network claimsEngage with...
-
Claims Processing Specialist
2 weeks ago
Plano, Texas, United States Woongjin, INC. Full timeCompany Overview For additional career opportunities, please visit our website: Our Vision WOONGJIN, Inc. is a dynamic organization dedicated to delivering a variety of exceptional and tailored services to our clientele. Our ethical framework is rooted in the principle of serving others without the expectation of compensation. We are driven by a commitment...
-
Insurance Claims Manager
5 days ago
Plano, Texas, United States CNA Full timeJob SummaryCNA is seeking a highly skilled Commercial Claims Specialist to join our team. As a key member of our claims department, you will be responsible for managing commercial claims with moderate to high complexity and exposure.Key ResponsibilitiesClaim Management: Investigate and resolve claims according to company protocols, quality and customer...
-
Insurance Claims Support Specialist
1 week ago
Plano, Texas, United States CornerStone Staffing Full timeJoin Our Team as a Claims Assistant!Are you an administrative professional eager to advance your career within a dynamic organization? CornerStone Staffing is seeking a dedicated Claims Assistant in the Insurance sector.Position Overview:Job Title: Claims AssistantCompensation: $19 per hourWork Schedule: Monday to Friday, 8 AM - 5 PM (30-Minute Lunch...
-
Claims Specialist II, Commercial Auto
4 weeks ago
Plano, United States Tokio Marine America Full timeAbout Tokio Marine:Tokio Marine has been conducting business in the U.S. market for over a century and we are licensed in all states, Puerto Rico and the District of Columbia, and write all major lines of Commercial Property and Casualty Insurance. We provide unique insurance and risk management tools from our experienced staff of account executives,...
-
Claims Specialist II, Commercial Auto
3 days ago
Plano, United States Tokio Marine America Full timeAbout Tokio Marine:Tokio Marine has been conducting business in the U.S. market for over a century and we are licensed in all states, Puerto Rico and the District of Columbia, and write all major lines of Commercial Property and Casualty Insurance. We provide unique insurance and risk management tools from our experienced staff of account executives,...
-
Insurance Claims Support Specialist
1 week ago
Plano, Texas, United States CornerStone Staffing Full timeJoin a Dynamic Team in the Insurance Sector Are you an administrative professional eager to advance your career? CornerStone Staffing is seeking a Claims Assistant to support our operations in the insurance industry. Position Overview: Location: Plano, TX Compensation: $19 per hour Work Schedule: Monday to Friday, 8 AM to 5 PM (30-minute lunch break) Key...
-
Onsite Medical Claims Specialist
3 weeks ago
Plano, United States Paramount Staffing LLC Full timeJob DescriptionJob DescriptionAre you an experienced call center representative in the healthcare industry looking to dive into your next opportunity? Paramount is seeking experienced Medical Claims Specialists to provide top-notch support to our valued clients.Position Overview: You will be responsible for assisting callers with inquiries, complaints, or...
-
Medical Bill/Claim Negotiator
3 months ago
Plano, United States The Reny Company Full timeJob DescriptionJob DescriptionPLEASE DO NOT APPLY IF YOU DON'T HAVE THE EDUCATION AND MEDICAL BILL REVIEW EXPERIENCEDaily responsibilities will include:Contacting medical providers to negotiate greatest discount/savings on out of network claims.Screening medical bills for possible negotiation and contacting medical providers via fax and telephone to...
-
Medical Claim Processor
3 months ago
Plano, United States The Reny Company Full timeJob DescriptionJob DescriptionTHIS IS NOT A REMOTE POSITION Job Description: The Reny Company's medical claim processor is a professional who combines experience in health insurance and medical billing with business insight and a passion for great service. The processor will work methodically as front-end support for our bill review department to ensure...
-
Medical Claims Data Entry
3 months ago
Plano, United States The Reny Company Full timeJob DescriptionJob DescriptionThe Reny Company's healthcare claims data entry personnel is a professional who combines experience in data entry, health insurance and medical billing with business insight and a passion for great service. The data entry personnel will ensure the highest level of accuracy of data entry into our bill review system for claims...
-
Commercial Auto Claims Adjuster II
1 week ago
Plano, Texas, United States Tokio Marine America Full timeAbout Tokio Marine:With over a century of experience in the U.S. market, Tokio Marine is a licensed provider in all states, Puerto Rico, and the District of Columbia, offering a comprehensive range of Commercial Property and Casualty Insurance. Our dedicated team of account executives, underwriters, and loss prevention engineers deliver unique insurance and...