Job Summary Under technical direction, investigates and maintains Workers' Compensation claims. Works within specific limits of authority on assignments requiring significant technical complexity and coordination. Utilizing claims policies and guidelines, reviews coverages, determines compensability, manages medical treatment, explores return to work opportunities, ensures accurate reserving, and negotiates and settles claims.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 timely payments while managing loss costs and expenses. 3. Coordinates and performs investigations and evaluates claims through contact with insureds, claimants, medical providers, 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. Ensures jurisdictional compliance as needed. 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.Reporting Relationship Manager or DirectorSkills, Knowledge & Abilities 1. Solid knowledge of claims and insurance industry theory and practices. 2. Demonstrated technical expertise, previous WC claim handling experience. 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 WC claims experience.
