Senior Claims Examiner

3 weeks ago

London, United Kingdom CNA Hardy Full time

**Position Summary**

We are seeking to hire a Senior Healthcare Claims Examiner to join our London team.

The role will work under limited technical direction, investigates and effectively handles complex Healthcare claims. Works within specific limits of authority on assignments requiring significant technical complexity and coordination. Utilising claims policies and guidelines, reviews coverages, determines liability and compensability, secures information and negotiates and settles claims.

**Key Responsibilities**
- With limited supervision, manages a portfolio of complex Healthcare claims, with a particular focus on claims against medical professionals.
- Coordinates and performs investigations and evaluates claims through contact with insureds, claimants, business partners, witnesses and experts. Seeks early resolution opportunities.
- Partners with solicitors, customers, brokers, experts and insureds to develop a focused strategy for timely and cost effective resolution of more complex claims.
- Proactively manages claims, setting appropriate reserves in line with reserving philosophy, and authorizing payments within scope of authority.
- Ensures large and significant claims are identified at an early stage and management are notified and kept advised in line with claims handling guidelines.
- Provide guidance, assistance and mentoring to less experienced claims staff and other function areas.
- Utilises negotiation skills to develop complex settlement packages.
- Identifies claims with third party recovery potential and coordinates with subrogation/salvage unit.
- Analyses claims activities. Prepares and presents reports for management. May be responsible for special projects and presentations.
- Keeps current on relevant regulations and issues as well as industry activity and trends.
- Comply with all applicable legal and regulatory requirements and ensure, at a level appropriate to the position, that appropriate measures are in place to ensure this compliance
- May perform additional duties as assigned.

**Skills, Knowledge & Experience**
- Significant proven claims handling experience, preferably with a focus on Healthcare / Medical Malpractice, Regulatory compliance, hearings and Inquests.
- Experience of handling claims against medical professionals and healthcare related entities preferred.
- Ability to handle claims with a proactive long-term view of business goals and objectives.
- Strong analytical and problem solving skills enabling viable alternative solutions.
- Ability to assess the merits of claims as well as evaluating claims based on a cost benefit analysis.
- Understanding of underwriting risk, disciplines and processes
- Strong interpersonal, communication and negotiation skills. Ability to effectively interact with all levels of CNA Hardy's internal and external business partners.
- Ability to adapt to change and value diverse opinions and ideas.
- Appropriate knowledge of all relevant regulatory and legal requirements applicable to the position

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