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Complex Claims Specialist

2 months ago

Lake Mary, Florida, United States CNA Financial Corporation Full time
Job Title: Complex Claims Consultant

We are seeking a highly skilled Complex Claims Consultant to join our dynamic Cyber, Technology, Media, Miscellaneous Professional Liability (MPL) team.

Job Summary:

The ideal candidate will have a strong understanding of commercial insurance policies and a proven track record of resolving complex claims. This role will involve managing an inventory of highly complex commercial claims, with large exposures that require a high degree of specialized technical expertise and coordination.

Key Responsibilities:
  • Manage complex commercial claims, including verifying policy coverage, conducting investigations, developing and employing resolution strategies, and authorizing disbursements within authority limits.
  • 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, partnering with coverage counsel on more complex matters, estimating potential claim valuation, and following company's claim handling protocols.
  • Lead focused investigations to determine compensability, liability, and covered damages by gathering pertinent information, 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, including 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 the line of business.
Requirements:
  • Thorough knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices.
  • Strong communication and presentation skills, both verbal and written, including the ability to communicate business and technical information clearly.
  • Demonstrated analytical and investigative mindset with critical thinking skills and the ability to make sound business decisions and effectively evaluate and resolve ambiguous, complex, and challenging business problems.
  • Strong work ethic, with demonstrated time management and organizational skills.
  • Ability to work in a fast-paced environment at high levels of productivity.
  • Demonstrated ability to negotiate complex settlements.
  • Experience interpreting complex commercial insurance policies and coverage.
  • Ability to manage multiple and shifting priorities in a fast-paced and challenging environment.
  • Knowledge of Microsoft Office Suite and ability to learn business-related software.
  • Demonstrated ability to value diverse opinions and ideas.
Education and Experience:
  • J.D. preferred.
  • 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 offers a comprehensive and competitive benefits package to help our employees - and their family members - achieve their physical, financial, emotional, and social well-being goals.