Company Overview:

Mitsui Sumitomo Marine Management U.S.A., Inc. is one of the world’s top ten property/casualty insurance carriers with over 40,000 employees worldwide.
Position Overview:

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*Summary:

This position is responsible to adjust assigned claims within delegated limits of authority, conduct timely and thorough investigations, handle subrogation claims, and complete fair and equitable claim settlements in accordance with MSMM Claim Handling Guidelines to ensure services are provided in a fair, equitable and timely manner.

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

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Claims Handling* 55%

• 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 company’s Litigation Management Program. Reviews and adjusts, where appropriate, fee bills and legal expenses for accuracy and reasonableness.

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Customer Service* 25%

• 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.
• Must be able to work on-site at the Customer’s location on a full time basis and participate in scheduled on-site meetings. Job requirements also include the ability to participate in on-site job process reviews on the production floor and in pre-surgery meetings with Injured Workers. MSIG apparel is required to be worn in the on-site claim setting, along with personal protective equipment on the production floor, both of which will be provided by MSMM.
• 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.

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Regulatory and Operational Compliance 20%*

• Completes timely and accurate data reports to state reporting agencies to ensured full compliance with MSMM and regulatory requirements.
• Maintains full compliance with all regulatory Fair Claim Practices Acts and state and federal regulations.
• 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.
• Participates and/or manages special projects and assignments as needed.

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Education and/or Experience*

• High School Degree or G.E.D. is required. Bachelor's degree preferred
• 7+ years related experience handling complex Liability or Workers’ Compensation Claims

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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.*

Job Type: Full-time

Pay: $80,000.00 - $100,000.00 per year

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: One location

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