Mitsui Jobs


Claims Adjuster - Medical Only

Mitsui Sumitomo Marine Management (U.S.A.), Inc. | Cincinnati | 5/16/2018


Mitsui Sumitomo Insurance Group is one of the world’s largest property/casualty insurance carriers with over 40,000 employees worldwide. Our US subsidiary, Mitsui Sumitomo Marine Management (MSMM), currently has an opportunity available for a Workers Compensation Representative in our Cincinnati, OH location.

Summary To adjust assigned medical only and lifetime medical workers' compensation claims within delegated limits of authority, conduct timely and thorough investigations and complete fair and equitable claim settlements in accordance with MSMM Claim Handling Guidelines that will ensure that services are provided in a fair, equitable and timely manner by performing the following duties.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

  1. Receives new claim assignment; analyzes the nature of the claim to determine required investigation and handling.  Determines and identifies compensability issue or questions of compensability in accordance with the MSMM Claims Handling Guidelines.
  1. Performs 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 manager where assigned authority is exceeded.
  1. 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.
  1. Maintains current case diary and ensures 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.
  1. Investigates and evaluates recovery potential.  Conducts 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 insured’s, brokers, providers, etc. in accordance with company policy and procedures.
  1. Partner with internal and external customers to bring about an appropriate claim resolution in a timely and effective manner in accordance with the MSMM Claims handling Guidelines

Education/Experience/Skills                                            

High School Degree/ G.E.D required.   Bachelor's degree preferred.

3+ years claims handling Medical Only/Lifetime only Medical Claims

Detail oriented and a team player

Excellent Customer Service skills

Excellent written and verbal communication skills

 

                             

 

JOB OVERVIEW

Location
Pay
Industry
Category
Career Level
Cincinnati
Competitive salary & comprehensive benefits package

Claims, Health and Medical , Workers' Compensation
Experienced (Non-Manager)

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