Attorney in Chicago, IL

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In-House

Chicago, IL

Attorney in Chicago, IL

Non-practicing Attorney

Min 6 yrs required

No

Job Title:
Complex Claims Consultant (Healthcare)

Job Responsibilities:
The Complex Claims Consultant in Healthcare is responsible for managing an inventory of highly complex healthcare professional liability claims. This role requires a high degree of specialized technical expertise and coordination. The consultant will:
- Verify policy coverage, conduct investigations, develop and employ resolution strategies, and authorize disbursements within authority limits.
- Ensure exceptional customer service by managing all aspects of the claim, interacting 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 timely and adequate reserves by reviewing and interpreting policy language, estimating potential claim valuation, working with counsel, and following the company's claim handling protocols.
- Lead focused investigations to determine compensability, liability, and covered damages by gathering pertinent information, such as contracts or other documents, taking recorded statements from customers, claimants, and witnesses, and working with experts or other parties as necessary to verify the facts of the claim.
- Resolve claims by collaborating with internal and external business partners to develop, own, and execute a claim resolution strategy that includes managing timely and adequate reserves, collaborating with coverage experts where necessary, negotiating complex settlements, partnering with counsel to manage complex litigation, and authorizing payments within the scope of authority.
- Establish and manage claim budgets by achieving timely claim resolution, selecting and actively overseeing appropriate resources, authorizing expense payments, and delivering high-quality service efficiently.
- 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 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 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.
- 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, guide, develop, and deliver training to less experienced Claim Professionals.

Education and Experience:
- A Bachelor's Degree or equivalent experience is required. A JD is considered a plus.
- Typically, a minimum of six years of relevant experience is needed, preferably in claim handling or healthcare/medical malpractice litigation.
- 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, such as CPCU (Chartered Property Casualty Underwriter).

Salary Information:
In Chicago, New York, and California, the average base pay range for the Complex Claims Specialist role is $113,000 to $160,000. Salary determinations are based on various factors, including but not limited to relevant work experience, skills, certifications, and location. In certain jurisdictions, the national base pay range for this job level is $72,000 to $141,000 annually. CNA offers a comprehensive and competitive benefits package to help employees and their family members achieve their physical, financial, emotional, and social wellbeing goals.

CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process.

Jun 19, 2025
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