Posted in Other 30+ days ago.
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Type: Full Time
Location: lake mary, Florida
Healthcare Claims is recruiting for a Claim Specialist position to work in our Hospitals, Allied Facilities and Physicians segment. The preferred location for this position is Portland, Chicago/Lisle, Wyomissing, Lake Mary, Tampa. Individual contributor responsible for the overall investigation and management of Hospitals, Allied Facilities and Physicians claims in multiple states. Recognized as a technical expert in the interpretation of complex or unusual policy coverages in area of expertise. Under general management direction, works within assigned limits of broad authority on assignments requiring a high degree of technical complexity, coordination and excellent customer service. This individual will also work closely with internal business partners such as Underwriting, to share claim insights to aid in good underwriting decisions.
Essential Duties & Responsibilities
1. Interprets more complex or unusual policy coverages and determines if coverages apply to claims submitted, escalating issues as needed.
2. Sets activities, reserves and authorizes payments within scope of authority. Ensures issuance of disbursements while managing loss costs and expenses.
3. Coordinates and performs investigations and evaluates claims and suits through contact with insureds, claimants, business partners, witnesses and experts. Seeks early resolution opportunities. Identifies files that have potential fraud and refers to SIU.
4. Utilizes negotiation skills to develop complex settlement packages.
5. Identifies claims with third party recovery potential and coordinates with subrogation/salvage unit.
6. Partners with attorneys, account representatives, agents, underwriters, doctors, nurse case managers and insureds to develop a focused strategy for timely and cost effective resolution of more complex claims.
7. Analyzes claims activities. Prepares and presents reports for management. May be responsible for special projects and presentations.
8. Responsible for input of data that accurately reflects claim circumstances and other information important to our business outcomes.
9. May provide guidance and assistance to other claims staff and functional areas.
10. Keeps current on state/territory regulations and issues as well as industry activity and trends.
May perform additional duties as assigned.
Manager or Director
Skills, Knowledge & Abilities
1. Solid knowledge of claims and insurance industry theory and practices.
2. Demonstrated technical expertise and product specific knowledge.
3. Strong interpersonal, communication and negotiation skills. Ability to effectively interact with all levels of CNA's internal and external business partners.
4. Ability to work independently, managing time and resources to accomplish multiple tasks and meet deadlines.
5. Strong analytical and problem solving skills enabling viable alternative solutions.
6. Ability to exercise independent judgement and make critical business decisions effectively assessing the merits of claims as well as evaluating claims based on a cost benefit analysis.
7. Solid knowledge of Microsoft Office Suite as well as other business-related software.
8. Ability to adapt to change and value diverse opinions and ideas.
9. Ability to fully comprehend claim information, and to further articulate analyses of claims in internal reports.
10. Ability to handle claims with a proactive long-term view of business goals and objectives.
Education & Experience
1. Bachelor's degree or equivalent experience. Professional designations preferred.
2. Typically a minimum three to five years claims experience.
Primary Location: United States-Oregon-Portland
Other Locations: United States-Oregon-Portland
Organization: CLAIM USSPL-Health Pro (H PRO)
Job Posting: May 11, 2018
Unposting Date: Ongoing.
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.