Complex Claims Consultant, Healthcare

Cna Employees' Health Plan Trust

Multiple Locations
Base: $113,000 to $160,000 (il/ny/ca); $72,000 to ...
Hybrid
Complex specialty claims management
Policy coverage interpretation
Investigation and resolution strategies
CNA Employees' Health Plan Trust is seeking a Complex Claims Consultant to manage intricate claims in the healthcare sector, particularly for aging services and hospitals. The position requires strong analytical and negotiation skills, with an emphasis on exceptional customer service and collaboration with various stakeholders

Job Summary

  • This role is responsible for the overall investigation and management of complex claims in the Aging Services and Hospitals, Allied Providers and Physicians segments across multiple states.
  • You will collaborate with insureds, attorneys, internal business partners, and other insurers to investigate and resolve claims, coordinate discovery, and team with defense counsel on litigation strategy.
  • The position offers a flexible, hybrid work schedule and can work from one of the listed CNA office locations.

Matching Summary

Match Score: 85

CNA Employees' Health Plan Trust is seeking a Complex Claims Consultant to manage intricate claims in the healthcare sector, particularly for aging services and hospitals. The position requires strong analytical and negotiation skills, with an emphasis on exceptional customer service and collaboration with various stakeholders.

Salary

Base: $113,000 to $160,000 (IL/NY/CA); $72,000 to $141,000 (DC, CA, CO, CT, IL, MD, MA, NY, WA); Benefits: Comprehensive package

Skills & Requirements

Must-have

  • Complex specialty claims management
  • Policy coverage interpretation
  • Investigation and resolution strategies
  • Negotiating complex settlements
  • Collaboration with internal/external partners

Nice-to-have

  • Technical expertise in healthcare claims
  • Mentoring and training junior professionals
  • Proactive identification of subrogation/fraud

Key Requirements

  • Minimum six years relevant experience
  • Prior negotiation experience
  • Bachelor's Degree or equivalent experience
  • Insurance Adjuster License required
  • JD a plus
  • Professional designations preferred

Work Rights

Not specified

Tailored Resume

Cover Letter