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 Claims Coordinator, (Bi-lingual Japanese / English), located in our New York City office.
Summary: To adjust assigned Overseas Travel Accident Insurance (OTAI) claims within delegated limits of authority, conduct timely and thorough investigations and complete fair and equitable claim settlements in accordance with MSIJ and MSMM Claim Handling Guidelines that will ensure services are provided in a fair, equitable and timely manner.
- Upon receipt of new claim assignments; analyze the nature of the claim to identify and determine coverage and thoroughly evaluate questions of compensability, to include required investigation and handling in accordance with the MSIJ requirements and/ MSMM Claims Handling Guidelines.
- Performs timely and thorough investigations in an effort to comply with all jurisdictional requirements and/or entitlements.
- Conducts an informed case analysis to address claim entitlements, initiate reserve changes within assigned authority, provide 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.
- Maintains current case diary and ensures appropriate file documentation.
- Provides accurate claim system documentation and paperless file 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.
- Investigates and evaluates recovery potential. Conducts timely and thorough subrogation investigation in accordance with company policy and procedures. Timely handling and referral of all claims involving recovery potential.
- Provide exceptional customer service to our customers, to include prompt responses to the insured’s, claimants, medical providers, etc. in accordance with company policy and procedures.
- Partner with internal and external customers to bring about an appropriate claim resolution in a timely and effective manner in accordance with MSIJ and MSMM Claims handling Guidelines.
This position has no supervisory responsibilities.
Education and Experience Required:
- Bachelor's degree (B. A.) from four-year college/ university preferred. High School Degree or G.E.D. required.
- Prior experience handling health insurance or other medical claims a plus. Knowledge of medical terminology.
- Fluent in Japanese.
Other Qualifications Required:
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization. Fluent in Japanese.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic.
Must have strong computer skills including Microsoft Word, Excel (the ability to create and format spreadsheets, sort, and create basic formulas). Must also have the ability to learn and implement other software.
Must have or obtain within one year from date of hire, adjuster license for state of New York.
New York City, New York
Competitive salary, benefits, and 401K!