Complex Claims Consultant - Medical Malpractice

About the role

You will support the business and interact with Allied Healthcare Providers, including nurses, nurse practitioners, physical therapists, counselors, pharmacists, massage therapists, and more than 100 other categories of medical service providers. This role involves investigating, managing, and resolving claims with moderate to high complexity and exposure.

Responsibilities

• Interpret complex or unusual policy coverages and work autonomously to manage professional liability healthcare claims.
• Collaborate with internal business partners like Underwriting to share claim insights that aid in good underwriting decisions.
• Partner with insureds, attorneys, other insurers, and account representatives to handle and/or dispose of complex litigated and non-litigated claims in multi-state jurisdictions.
• Investigate and resolve claims, coordinate discovery, and work with defense counsel on litigation strategy.
• Utilize claims policies and guidelines, review coverage, determine liability and damages, set financial reserves, secure information to negotiate and settle claims.

Requirements

This role requires a bachelor's degree or equivalent experience, typically six years or more, preferably in claim handling or medical malpractice litigation. An Insurance Adjuster License must be obtained within 90 days of hire, where applicable. Professional designations are preferred (e.g., CPCU).

Qualifications

Thorough knowledge of the commercial insurance industry, products, policy language, coverage, and claim practices. Strong communication and presentation skills, including the ability to communicate business and technical information clearly. Demonstrated analytical and investigative mindset with critical thinking skills and ability to make sound business decisions. 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.

Skills

• 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 ability to make sound business decisions, and to 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.

Benefits

CNA offers a comprehensive and competitive benefits package to help employees – and their family members – achieve their physical, financial, emotional, and social wellbeing goals. For a detailed look at CNA’s benefits, please visit cnabenefits.com.