Senior Claims Rep - Workers' Compensation

Mitsui Sumitomo Insurance Group (MSIG) is one of the world’s top ten property/casualty insurance carriers with over 38,000 employees worldwide. MSIG insures large multinational and domestic companies, and offers comprehensive global insurance programs.  Our US subsidiary, Mitsui Sumitomo Marine Management (MSMM), currently has an opportunity available for Senior Claims Representative – Workers’ Compensation in our Los Angeles California office.

SUMMARY:  To adjust assigned workers’ compensation claims within delegated limits of authority, conduct timely and thorough investigations, and complete fair and equitable claim settlements.

1. Analyze the nature of the claim to determine required investigation and handling. Determine and identify coverage issues or questions of compensability in accordance with Claims Handling Guidelines.

1. Perform timely and thorough investigations in an effort to comply with all jurisdictional requirements and/or entitlements.

1. Conducts an informed case analysis to address claim entitlements. Initiate reserve changes within assigned authority, makes recommendations to supervisor or manger where assigned authority is exceeded

1. Manage, control and negotiate timely and equitable claim payments and settlements in accordance with jurisdictional and fair claims practices requirements and company policy and procedures.

1. Investigate, evaluate and resolve moderate level litigated files including all aspects of litigation management in accordance with the Claims Handling Guidelines.

1. Maintain current case diary and ensure appropriate file documentation.Responsible for completion and/or submission of claim forms and reports as required by outside agencies.

1. Investigate and evaluate recovery potential. Conduct timely and thorough subrogation investigation in accordance with company policy and procedures.  Timely completion and referral of all claims involving recovery potential.

1. Service the claim needs of our customers, including insureds, claimants, brokers etc. in accordance with company policy and procedures.

Experience/Education

• Bachelor's degree (B. A.) preferred;  5+ years related WC claims experience  Completion of insurance and/or claims courses preferred (IAA, AEI, CPCU).

We are committed to providing the highest quality products and services to our customers.Mitsui Sumitomo offers a wide range of benefits and is an equal opportunity employer.

If you have the required skills and experience and are interested in working in a challenging environment, please email your resume with salary requirements.