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MSIG USA · 2 months ago

Senior Claims Representative (Workers Compensation)

AL-Huntsville

Full-time

Hybrid

Senior Level

5+ years exp

MSIG USA is the US-based subsidiary of MS&AD Insurance Group Holdings, Inc., a global Class 15 insurer. The Senior Claims Representative is responsible for adjusting assigned claims, conducting investigations, and ensuring fair claim settlements in accordance with company guidelines.

FinanceFinancial ServicesInsurance

Responsibilities

Receives new claim assignments of a moderate to complex nature and analyzes the nature of the claim to determine required investigation and handling. Determines and identifies indemnity issues or questions of coverage in accordance with MSMM Claims Handling Guidelines and/or requirements of principals regarding TPA business

Performs timely and thorough investigations including necessary survey arrangement in compliance with all jurisdictional requirements and/or entitlements

Conducts an informed case analysis to initiate reserve changes within assigned authority and makes recommendations to supervisor or manager where assigned authority is exceeded

Manages, controls and negotiates timely and equitable claim payments and settlements in accordance with jurisdictional and fair claims practice requirements and company policy and procedures. Investigates, evaluates and resolves moderate level claims files

Maintains current case diary and ensures retention of appropriate hard copy file documentation. Provides accurate claims system documentation as required by company claim manuals and procedures. Responsible for completion and/or submission of claim forms and reports as required by outside agencies

May handle subrogation of claims within delegated limits of authority, including identification of responsible parties, preparation of claim notice, correspondence with carriers, and negotiation of settlement in accordance with MSMM Recovery Procedures

May be required to assign the defense of lawsuits to approved defense counsel; directs and monitors quality and performance of defense counsel. Maintains compliance with all requirements of the company’s Litigation Management Program. Reviews and adjusts, where appropriate, fee bills and legal expenses for accuracy and reasonableness

Services the claim needs of our customers including insureds, claimants, brokers, etc., in accordance with company policy and procedures, and attends client visitations with underwriters and other parties to conduct presentations and reviews

Maintains ongoing communication with all customers throughout the claims process in an effort to provide timely and appropriate claim status as appropriate and/or required by statutory regulations

Completes timely and accurate data reports to state reporting agencies to ensured full compliance with MSMM and regulatory requirement

Maintains full compliance with all regulatory Fair Claim Practices Acts and state and federal regulations

Maintains full compliance with all state licensing and continuing education requirements to ensure current and appropriate filing/standing of all adjuster licenses

Qualification

Claims experienceInvestigation skillsNegotiation skillsRegulationsCommunication skills

Required

High School Degree or G.E.D. is required

5+ years of claims experience, including ability to successfully negotiate settlements, verify coverage, appropriately set reserves, successfully complete investigations and understand rules associated with state regulations