Mitsui Jobs

Claims Specialist (Workers Compensation)

Mitsui Sumitomo Marine Management (U.S.A.), Inc. | Warren, New Jersey | 10/28/2020

Location Warren, NJ Posted October 27, 2020 Category Claims

Company Overview:

Mitsui Sumitomo Marine Management U.S.A., Inc. is one of the worlds top ten property/casualty insurance carriers with over 40,000 employees worldwide.

Position Overview:

This position is responsible to conduct thorough investigations and evaluate and negotiate complex claims including litigation and coverage issues. Accountable to ensure compliance with MSMM Claim Handling Guidelines, including reserving and payment practices, regulatory requirements and Fair Claims Practices Acts.

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

  • Investigates, researches and analyzes highly complex or severe claims, including coverage issues and legal issues affecting liability and damages.
  • Establishes appropriate case reserves, completes settlements and case resolutions within established reserve and settlement authorities. Recommends reserve and settlement values on assigned cases in excess of established reserve and settlement authority.
  • Manages, controls and negotiates timely and equitable claim payments and settlements in accordance with jurisdictional and fair claim practices and company policy and procedures.
  • Attends pre-trials, trials, settlement conferences and mediations on assigned cases as required.
  • Assigns the defense of lawsuits to approved defense counsel; directs and monitors quality and performance of defense counsel. Maintains compliance with all requirements of the companys Litigation Management Program. Reviews and adjusts, where appropriate, fee bills and legal expenses for accuracy and reasonableness.
  • Services the claim needs of our customers including insureds, claimants, brokers, etc., in accordance with company policy and procedures, and attends client visitations with underwriters and other parties to conduct presentations and reviews.
  • Maintains ongoing communication with all customers throughout the claims process in an effort to provide timely and appropriate claim status as appropriate and/or required by statutory regulations.
  • Completes timely and accurate data reports to state reporting agencies to ensured full compliance with MSMM and regulatory requirement.
  • Completes timely and accurate data reports to state reporting agencies to ensured full compliance with MSMM and regulatory requirement.
  • Maintains full compliance with all state licensing and continuing education requirements to ensure current and appropriate filing/standing of all adjuster licenses.
  • Maintains regular reporting of case status, developments and direction to Home Office staff and other appropriate parties as necessary. Ensures timely and appropriate file reports and system documentation as required by company claim manuals and procedures.
  • Maintains full compliance with all regulatory Fair Claim Practices Acts and state and federal regulations.
  • Participates and/or manages special projects and assignments as needed.

    Education and/or Experience

    • High School Degree or G.E.D. is required. Bachelors degree preferred
    • 7+ years related experience handling complex Liability or Workers Compensation Claims
    • Heavy emphasis on New York claims handling and regulatory/compliance requirements.
    • MUST HAVE New York Workers Comp experience

    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.



    Career Level
    Warren, New Jersey
    Not Specified

    Not Specified

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