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Workers Compensation Claims Specialist
CNA Insurance. Investigate and maintain Long Term Care claims .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Long Term Care claims management, including investigation, negotiation, and settlement processes. Proficient in analyzing claims data, coordinating with various stakeholders, and maintaining compliance with state regulations.
Highest-signal resume keywords
Claims InvestigationNegotiation SkillsAnalytical Problem SolvingCalifornia CertificationMicrosoft Office Suite
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ManagementPolicy Coverage InterpretationSettlement Package DevelopmentFraud IdentificationSubrogation CoordinationData AnalysisReport PreparationTime ManagementIndependent Judgment
Soft Skills
Interpersonal SkillsCommunication Skills
Tools & Technologies
Business-Related Software
Certifications & Qualifications
California Certification
Industry Keywords
Insurance Industry PracticesLong Term Care ClaimsCompensabilityLiability DeterminationRegulatory Compliance
About the role
Key responsibilities & impact- Investigate and maintain Long Term Care claims
- Review coverages, determine liability and compensability, secure information, and negotiate and settle claims
- Interpret complex or unusual policy coverages and escalate issues as needed
- Set activities and reserves and authorize payments within scope of authority
- Coordinate investigations and evaluate claims and suits through contact with insureds, claimants, business partners, witnesses, and experts
- Identify potential fraud files and refer them to SIU
- Develop complex settlement packages through negotiation
- Identify third-party recovery potential and coordinate with subrogation/salvage
- Partner with attorneys, account representatives, agents, underwriters, doctors, nurse case managers, and insureds to resolve complex claims
- Analyze claims activities and prepare and present management reports
- Input accurate claim data and information
- Provide guidance and assistance to claims staff and functional areas
- Keep current on state and territory regulations, issues, industry activity, and trends
- Perform special projects, presentations, and additional assigned duties
Requirements
What you’ll need- Bachelor's degree or equivalent experience
- Typically a minimum three to five years claims experience
- Solid knowledge of claims and insurance industry theory and practices
- Demonstrated technical expertise and product specific knowledge
- Strong interpersonal, communication and negotiation skills
- Ability to work independently, manage time and resources, accomplish multiple tasks and meet deadlines
- Strong analytical and problem solving skills
- Ability to exercise independent judgment and make critical business decisions
- Solid knowledge of Microsoft Office Suite and other business-related software
- Ability to fully comprehend and articulate claim analyses in internal reports
- California experience and California certification preferred
- If not certified, willingness to complete certification within the first month of hire
Benefits
Comp & perks- Comprehensive and competitive benefits package
- Benefits supporting employees’ and family members’ physical, financial, emotional and social wellbeing goals