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Complex Claims Specialist

1 month ago

Chicago, Illinois, United States CNA Full time
Job Title: Complex Claims Specialist

We are seeking a highly skilled and experienced Complex Claims Specialist to join our team at CNA. As a key member of our claims team, you will be responsible for managing and resolving complex legal malpractice claims.

Key Responsibilities:
  • Manage an inventory of moderate to high complexity and exposure commercial claims by following company protocols to verify policy coverage, draft coverage letters, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits.
  • Provide exceptional customer service by establishing relationships and interacting professionally and effectively with insureds, claimants, defense counsel, and internal and external business partners, providing regular, timely updates and responding promptly to inquiries and requests for information.
  • Verify coverage by reviewing and interpreting policy language and partnering with coverage counsel on more complex matters and drafts coverage letters.
  • Conduct focused investigation to determine compensability, liability and covered damages by gathering pertinent information, such as contracts or other documents, taking statements from customers, claimants, injured workers, witnesses, and working with experts, defense counsel, or other parties, as necessary to verify the facts of the claim.
  • Establish timely and adequate reserves by estimating potential claim valuation based on focused investigation and in accordance with company's claim handling protocols.
  • Authorize and ensure claim disbursements within authority limit 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 such as our leading panel of defense attorneys or experts, and delivering high quality service.
  • Identify and address subrogation/recovery opportunities or potential fraud occurrences by evaluating the facts of the claim and making referrals to appropriate internal Recovery or Special Investigations Unit 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 line of business.
Requirements:
  • Solid working knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices, based on either direct claim handling experience or experience at law firms that defend insurance industry clients.
  • Strong 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
Education and Experience:
  • Bachelor's Degree or equivalent experience. JD preferred.
  • Typically a minimum four years of relevant experience, preferably in claim handling or the defense of professionals.
  • 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).

CNA is an equal opportunity employer and welcomes applications from diverse candidates. We are committed to providing a work environment that is inclusive and respectful of all employees. If you are a motivated and experienced professional looking for a new challenge, please submit your application.