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Complex Claims Specialist

1 month ago

Brea, California, United States CNA Full time
Job Title: Complex Claims Consultant

CNA is seeking a highly skilled Complex Claims Consultant to join our team. As a key member of our claims organization, you will be responsible for managing complex commercial claims, providing exceptional customer service, and ensuring timely and adequate reserves.

Key Responsibilities:
  • Manage an inventory of highly complex commercial claims, with large exposures that require a high degree of specialized technical expertise and coordination.
  • Ensure 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.
  • Verify coverage and establish timely and adequate reserves by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters.
  • Lead focused investigations 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.
  • Resolve 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.
  • Establish and manage 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.
  • Realize and address 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.
  • Achieve 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.
  • Keep 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.
  • Maintain subject matter expertise and ensure compliance with state/local regulatory requirements by following company guidelines and staying current on commercial insurance laws, regulations, or trends for line of business.
  • Mentor, guide, develop, and deliver training to less experienced Claim Professionals.
Requirements:
  • Bachelor's Degree or equivalent experience.
  • 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).

CNA is an equal opportunity employer and welcomes applications from diverse candidates. We offer a competitive salary and benefits package, as well as opportunities for professional growth and development.