Claims Management Specialist

2 weeks ago

Brea, California, United States CNA Full time

At CNA, we believe in empowering our employees to realize their career aspirations. Our leadership is dedicated to fostering a culture where every individual feels valued and integral to our mission.

This role operates under direct supervision and adheres to established authority limits, focusing on the management of commercial claims characterized by low to moderate complexity and exposure within a designated line of business. Key responsibilities encompass the investigation and resolution of claims in alignment with company protocols, quality benchmarks, and customer service expectations. Regular interaction with clients and policyholders is essential, and the position may involve dedicated account management.

ROLE OVERVIEW:

Core Responsibilities:

Engages in a variety of tasks in accordance with departmental standards:

  • Oversees a portfolio of commercial claims of low to moderate complexity by adhering to company protocols to confirm policy coverage, collect necessary information, maintain accurate file documentation, and authorize payments within designated limits.
  • Enhances customer satisfaction through professional interactions with policyholders, claimants, and business partners, meeting quality and turnaround time objectives, providing timely updates, and responding promptly to inquiries.
  • Confirms coverage and establishes adequate reserves by analyzing policy language, estimating potential claim values, and following the company's claims handling procedures.
  • Utilizes sound judgment to assess liability and compensability by conducting thorough investigations, gathering relevant information, and collaborating with experts to validate claim facts.
  • Collaborates with internal and external partners, suppliers, and experts by identifying and engaging necessary resources to ensure optimal claim outcomes.
  • Authorizes and ensures claim payments within authority limits by determining liability and compensability, negotiating settlements, and escalating issues to management as needed.
  • Develops skills in expense management by resolving claims efficiently, selecting and overseeing appropriate resources, and delivering high-quality service.
  • Identifies and addresses subrogation and salvage opportunities or potential fraud by evaluating claim facts and referring to appropriate recovery or special investigation units for further action.
  • Maintains quality standards for every file by adhering to company guidelines, achieving quality and turnaround targets, ensuring proper documentation, and issuing appropriate claim payments.
  • Ensures compliance with state and local regulations by following company policies and staying informed about commercial insurance laws and trends relevant to the line of business.
Additional duties may be assigned as necessary.

Reporting Structure:

Typically reports to a Manager or higher.

Required Skills and Qualifications:
  • Developing foundational knowledge of the commercial insurance sector, products, and claims practices.
  • Strong verbal and written communication skills, demonstrating empathy while providing exceptional customer service.
  • Able to cultivate collaborative relationships with both internal and external stakeholders.
  • Capable of exercising independent judgment, solving basic issues, and making informed business decisions.
  • Analytical mindset complemented by critical thinking abilities.
  • Demonstrates a strong work ethic, effective time management, and organizational skills.
  • Ability to juggle multiple priorities in a dynamic, collaborative environment while maintaining high productivity levels.
  • Proficient in Microsoft Office Suite and quick to learn business-related software.
  • Adaptable to changing circumstances.
  • Values diverse perspectives and ideas.
Education and Experience:
  • High school diploma required; Associate's or Bachelor's degree preferred.
  • Must obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.
  • Prior experience in claims handling or customer service within the insurance industry is preferred.
CNA is committed to providing reasonable accommodations to qualified individuals with disabilities throughout the recruitment process.

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