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High-Severity Claims Consultant

2 months ago

Trenton, New Jersey, United States CNA Insurance Full time
Job Summary

CNA Insurance is seeking a highly skilled Complex Claims Consultant to join our Financial Lines Claims team. As a key member of our team, you will be responsible for investigating and maintaining complex professional liability claims, working within specific limits of authority on assignments requiring significant technical complexity and coordination.

Key Responsibilities
  • Manage Complex Claims: Perform a combination of duties in accordance with departmental guidelines, including managing an inventory of highly complex litigated claims, verifying policy coverage, conducting investigations, developing and employing resolution strategies, and authorizing disbursements within authority limits.
  • Provide Exceptional Customer Service: Ensure exceptional customer service by managing all aspects of the claim, interacting and communicating 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 Reserves: 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: Lead focused investigations to determine independent assessment of liability and damages by gathering pertinent information, such as contracts or other documents, as necessary to verify the facts of the claim.
  • Resolve Claims: 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: 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: 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: 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: Keep senior leadership informed of significant risks and losses by completing loss summaries, identifying claims to include on oversight lists, and preparing and presenting succinct summaries to senior management.
  • Maintain Subject Matter Expertise: 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.
  • Mentor and Develop Less Experienced Claim Professionals: Mentor, guide, develop, and deliver training to less experienced Claim Professionals.
Requirements
  • Advanced Technical Expertise: Advanced technical and product-specific expertise, claims resolution skill, and knowledge of insurance and claims principles, practices, and procedures.
  • Strong Communication and Negotiation Skills: Strong communication, negotiation, and presentation skills, both verbal and written, including the ability to communicate business and technical information clearly.
  • Demonstrated Analytical and Investigative Mindset: 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 and Time Management Skills: Strong work ethic, with demonstrated time management and organizational skills.
  • Ability to Work in a Fast-Paced Environment: Ability to work in a fast-paced environment at high levels of productivity.
  • Professional Designations Preferred: Professional designations preferred (e.g., CPCU).
Education and Experience
  • Bachelor's Degree or Equivalent Experience: Bachelor's Degree or equivalent experience. Juris Doctorate is preferred.
  • Minimum Six Years of Relevant Experience: Typically a minimum six years of relevant experience, preferably in Professional Liability claim handling or a minimum of six years in a law firm handling Professional Liability matters.
  • Insurance Adjuster License: Must have or be able to obtain and maintain an Insurance Adjuster License within 90 days of hire, where applicable.