Mitsui Sumitomo Insurance Group is one of the world’s top ten property/casualty insurance carriers with over 40,000 employees worldwide. We have an opportunity available for a Sr. Internal Auditor to work out of our Warren, NJ office.
Plans, organizes, manages claim staff and controls the activities in the Branch Claim Office within specific guidelines, directives and authority to ensure work is being managed properly to ensure high customer service levels.
Responsible for the implementation and practice of all claims handling guidelines and directives as outlined in various claim manuals, policies and bulletins to ensure regulatory and company compliance. Is also responsible to adjust assigned claims within delegated limits of authority, conduct investigations and complete fair and equitable claim settlements.
Essential Duties and Responsibilities include the following:
- Receives new claim assignments and analyzes the nature of the claim or loss to determine required investigation and handling. Determines and identifies coverage issues or questions of compensability.
- Is responsible for ensuring proper assignment and management of Workers’ Compensation claims adjusted within the Branch Claim Office. Ensures compliance with the investigation, management and settlement of all reported claims in accordance with MSMM Claim Handling Guidelines, jurisdictional regulations and Fair Claims Practices Acts.
- Is accountable for establishing and authorizing timely and adequate case reserves within delegated reserve/settlement authority and provides appropriate recommendations to Management where reserve evaluation exceeds delegated authority.
- Responsible for conducting and or supervising all necessary information related to assigned claims in the Branch Claim Office, as well as evaluating completed investigation and case facts to determine merits of each claim.
- Conducts internal quality control audits to ensure full compliance with MSMM Financial, Operational and Claims Handling Guidelines.
- Maintains diary and ensures appropriate file documentation and claims system documentation as required by company claim manuals and procedures. May be responsible for submission of claim forms and reports required by outside agencies.
- Investigates and evaluates recovery and fraud potential. Provides oversight and instructions on all recovery and special investigation activities to ensure full compliance with all MSMM and regulatory requirements.
- Communicates to claims staff information regarding policy, plans, trends, results and objectives of the company.
- Ensures Home Office Claim Staff (MSMM) is informed of all new and continuing developments on claims being reportable under published guidelines.
- Ensures compliance with all adjuster licensing regulations and requirements.
- Participates in miscellaneous associations; trade groups to ensure remains up to date in all regulatory and trade news and regulatory updates.
- Participates and/or manages special projects and assignments as needed.
Education and/or Experience
- Bachelor’s degree is preferred.
- 7+ years related WC Claims experience is required
- 4+ years in supervisory or management role
- AIC, CPCU, or Claims Law Designation preferred
- Read, analyze, and interpret general business periodicals, professional.
- Write reports, business correspondence and presentations.
- Create effective presentations and effectively deliver them and other information verbally, plus respond positively to questions from groups of managers, customers and the general public.
- Ability to accurately calculate figures and amounts such as discounts, interest, commissions, percentages, etc.
- Solve day-to-day business problems and deal with a variety of concrete variables in situations where only limited standardization exists.
- Interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
- Must be able to develop and maintain strong business relationships as well as having the ability to deal effectively with difficult or sensitive situations.
- Must be able to work independently and as part of a team
- Same day and overnight travel required ( 10%)
Word, Excel, PowerPoint. Knowledge of claim application systems including IVOS and Guidewire preferred
If you have the required skills and experience and are interested in working in a challenging environment, please email your resume with salary requirements to: firstname.lastname@example.org
The Company is an Equal Opportunity / Affirmative Action employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.
Warren, New Jersey
Salary + bonus
Claims, Workers' Compensation