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Senior Claims Representative

Employer
Mitsui Sumitomo Marine Management (U.S.A.), Inc.
Location
Los Angeles, California
Salary
Not Specified
Closing date
Oct 12, 2019

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Category
Claims
Job Type
Not Specified
Career Level
Not Specified

Job Details

Location Los Angeles, CA Posted July 2, 2019 Category Claims

Company Overview: MSIG Holdings (Americas), Inc. (MSIG) is a wholly owned subsidiary of the MS & AD Insurance Group Holdings, Inc. – one of the top ten property-casualty insurance groups world-wide. Our Group has capital in excess of $25 Billion, operations in more than 40 countries and nearly 40,000 personnel located globally.

Position Overview: To adjust assigned workers’ compensation lost time 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.

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

  • Receive new claim assignments. Analyze the nature of the claim to determine required investigation and handling. Determine and identify coverage issues or questions of compensability in accordance with the MSMM Claims Handling Guidelines.
  • Perform 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, makes recommendations to supervisor or manger where assigned authority is exceeded
  • 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.
  • Investigate, evaluate and resolve moderate level litigated files including all aspects of litigation management in accordance with the MSMM Claims Handling Guidelines.
  • Maintain current case diary and ensure appropriate hard copy file documentation. Provide 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.
  • 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.
  • Service the claim needs of our customers, including insureds, claimants, brokers 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 the MSMM Claims Handling Guidelines.
  • Other Duties as assigned

EDUCATION and/or EXPERIENCE

  • Bachelor’s degree (B. A.) preferred
  • 3+ years related WC claims experience Completion of insurance and/or claims courses preferred (IAA, AEI, CPCU)
  • Knowledge of CA WC laws.

REQUIREMENTS

  • Must have excellent attention to detail and organizational skills.
  • Must have excellent follow-up skills to ensure required responses are received and work gets accomplished in a timely manner.
  • Must have excellent customer service skills to ensure our internal clients are serviced professionally, effectively and in a timely manner.
  • Must have strong computer skills including MS Office skills including Word, Excel (the ability to create and format spreadsheets, sort, and create basic formulas), and the ability to learn and implement other softwares.

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.

Company

The primary purpose of Mitsui Sumitomo Marine Management (U.S.A.), Inc. (MSMM) is to manage the business affairs of two insurance companies: Mitsui Sumitomo Insurance Company of America and Mitsui Sumitomo Insurance USA Inc.

Our organization is structured in a manner that allows our service professionals to work hand-in-hand with our insured and producers to create coverage and service plans unique to each client. The resulting programs are geared toward the proper implementation of sound risk management procedures which lead to the effective management of exposures to loss, loss costs and total premium expense.

When joining MSMM, you are becoming part of a worldwide team that is dedicated to:

  • Making a lasting contribution to the enrichment of society by bringing security and safety to people and businesses around the world through the sale and servicing of its insurance products;
  • Realizing customer satisfaction by working to provide the finest products and services to consistently meet our clients' growing needs; and
  • Meeting our shareholders' expectations and strengthening their trust in us by continuously improving our business.

 

We value each employee's unique set of skills and contributions and believe that each employee plays an important role in the success of MSMM. 

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Mitsui Sumitomo Marine Management (U.S.A.), Inc.

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