Claims Resolution Specialist

4 weeks ago

Warren, United States CNA Full time
Job Summary

CNA is seeking a skilled Claims Resolution Specialist to join our team. As a key member of our commercial insurance claims team, you will be responsible for managing complex claims, providing exceptional customer service, and collaborating with internal and external stakeholders to resolve claims efficiently and effectively.

Key Responsibilities
  • Manage 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.
  • Provide 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.
  • Verify coverage and establish 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.
  • Conduct 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.
  • Establish and maintain 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.
  • Authorize and ensure claim disbursements within authority limits by determining liability and compensability of the claim, negotiating settlements, and escalating to manager as appropriate.
  • Contribute to expense management by timely and accurately resolving claims, selecting and actively overseeing appropriate resources, and delivering high-quality service.
  • Identify and address 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.
  • Achieve quality standards on every file by following all company guidelines, achieving quality and cycle time targets, ensuring proper documentation, and issuing appropriate claim disbursements.
  • Maintain compliance with state/local regulatory requirements by following company guidelines and staying current on commercial insurance laws, regulations, or trends for the line of business.
  • May serve as a mentor/coach to less experienced claim professionals.
Requirements
  • 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 judgment, 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.
Education and Experience
  • 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).

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