Insurance Nurse Reviewer Jobs in Michigan (NOW HIRING)

You have a clear vision of where your career can go. And we have the leadership to help you get there.  At CNA, we strive to create a culture in which people know they matter and are part of something important, ensuring the abilities of all employees are used to their fullest potential. 

Individual contributor responsible for the overall strategic management and resolution of highly complex claims that involve personal and advertising injury exposures, including but not limited to intellectual property, class action, and commercial disparagement. Review coverage and formulate coverage position letters based on jurisdictional issues and relevant case law. Responsibilities include the coordination of all claim resolution activities in accordance with company protocols, while achieving quality and customer service standards. Position requires regular communication with customers and insureds and may be dedicated to specific account(s).

JOB DESCRIPTION:

Essential Duties & Responsibilities

• Performs a combination of duties in accordance with departmental guidelines.
• Manages highly complex investigations of claims, including coverage issues, liability, compensability and damages. Determines if a major claim should be settled or litigated and implements an appropriate resolution strategy accordingly.
• Effectively manages loss costs and claim expenses.
• Manages all types of investigative activity or litigation on major claims, including the posting of appropriate reserves in a timely manner. Coordinates discovery and litigation strategy with staff counsel or panel attorneys.
• Negotiates highly complex settlement packages, and authorizes payment within scope of authority, settling claims in most cost-effective manner and ensuring timely issuance of disbursements.
• Coordinates third party recovery with subrogation/salvage unit.
• Makes recommendations on claims processes and resolution strategies to management.
• Analyzes claims activities; prepares and presents reports to management and other internal business partners and clients.
• Works with attorneys, account representatives, agents, doctors and insureds regarding the handling and/or disposition of highly complex claims.
• Keeps current on state/territory regulations and issues, industry activity and trends.
• May participate in industry trade groups.
• Provides guidance and assistance to less experienced claims staff and other functional areas.
• Responsible for input of data that accurately reflects claim circumstances and other information important to our business outcomes.

Reporting Relationship

• Manager or above.

Skills, Knowledge and Abilities

• Advanced technical and product specific expertise, claims resolution skill and knowledge of insurance and claims principles, practices and procedures.
• Strong communication, negotiation and presentation skills.
• Ability to effectively interact with all levels of CNA's internal and external business partners.
• Advanced analytical and problem-solving skills, with the ability to manage and prioritize multiple projects.
• Ability to deal with ambiguous situations and issues.
• Creativity in resolving unique and challenging business problems.
• Knowledge of Microsoft Office Suite and other business-related software.
• Ability to adapt to change and value diverse opinions and ideas.
• Ability to manage and prioritize multiple projects.
• Ability to evaluate claims based on a cost benefit analysis.
• Ability to fully comprehend complex claim facts and issues; and to further articulate analyses of claims in presentations to business partners and management as well as in internal reports.
• Ability to implement strategies with a proactive long-term view of business goals and objectives.

Education and Experience

• Bachelor's degree or equivalent experience. Professional designation preferred.
• Typically a minimum eight years claims experience.

#LI-Cp1 #LI-Hybrid

In certain jurisdictions, CNA is legally required to include a reasonable estimate of the compensation for this role. In District of Columbia ,California, Colorado, Connecticut, Illinois , Maryland , Massachusetts , New York and Washington, the national base pay range for this job level is $72,000 to $141,000 annually. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location. CNA offers a comprehensive and competitive benefits package to help our employees – and their family members – achieve their physical, financial, emotional and social wellbeing goals.  For a detailed look at CNA’s benefits, please visit cnabenefits.com .

CNA utilizes AI-enabled technology during the recruiting process. For more information, please visit our careers page .

CNA is committed to providing reasonable accommodations to qualified individuals with disabilities in the recruitment process. To request an accommodation, please contact