Complex Claims Consultant - Aging Services​/Medical Malpractice

Complex Claims Consultant – Aging Services/Medical Malpractice

At CNA Insurance we strive to create a culture where employees matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential.

CNA is a market leader in insuring skilled nursing, assisted living and independent living facilities. This individual‑contributor role supports the business and works closely with internal partners such as Underwriting to share claim insights that aid in good underwriting decisions.

The position is a flexible, hybrid schedule and is available in any location near a CNA office.

• Manages an inventory of highly complex commercial claims, with large exposures that require a high degree of specialized technical expertise and coordination, following company protocols to verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits.
• Ensures exceptional customer service by managing all aspects of the claim, interacting professionally and effectively, achieving quality and cycle time standards, and providing timely updates and responding promptly to inquiries and requests for information.
• Verifies coverage and establishes 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 the company’s claim handling protocols.
• Leads focused investigation 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.
• Resolves claims by collaborating with internal and external business partners to develop, own and execute a claim resolution strategy, managing timely reserves, collaborating with coverage experts, negotiating complex settlements, partnering with counsel to manage complex litigation, and authorizing payments within scope of authority.
• Establishes and manages claim budgets by achieving timely claim resolution, selecting and actively overseeing appropriate resources, authorizing expense payments and delivering high‑quality service efficiently.
• Realizes and addresses 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.
• Achieves quality standards by ensuring all company protocols are followed, work is accurate and timely, files are properly documented and claims are resolved and paid promptly.
• Keeps 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.
• Maintains subject‑matter expertise and ensures compliance with state/local regulatory requirements, following company guidelines and staying current on commercial insurance laws, regulations or trends for the line of business.
• Mentors, guides, develops and delivers training to less experienced Claim Professionals.

• 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…