Claims Specialist

MSIG USA continues to grow!

Company Overview:

MSIG USA

is the US-based subsidiary of

MS&AD Insurance Group Holdings, Inc.

, one of the world’s top P&C carriers and a global Class 15 insurer, with A+ ratings and a reach that spans 40+ countries and regions. Leveraging our 350-year heritage, MSIG USA brings the financial strength, expertise, and global footprint to offer commercial insurance solutions that address your business’s unique risks.

Summary/Job Purpose:

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.

Essential Functions:

Receives new claim assignments, analyzes the nature of the claim/loss to determine required investigation and handling. Determines and identifies coverage issues or questions of claim compensability.

Is responsible for direct handling Medical-only, Complex Medical-only claims in full compliance with Special Claim Handling Requirements & MSMM Claim Handling Guidelines. Claim handling responsibilities also involve frequent and professional claim handling interaction with the Customer, Injured Workers, and Medical Personnel and the Insurance Broker.

Conducts an investigation to collect all necessary information for assigned claims and appropriately evaluates completed investigation and case facts to determine merits of each claim. Requests job process investigations from MSMM staff who are on-site at the respective Toyota/MTMUS Plants where indicated. Participates in Complex Case Meetings in full compliance with Special Claim Handling requirements by plant affiliate location.

Initiates reserve changes within assigned authority, makes recommendations to supervisor manager where assigned authority is exceeded.

Ensures IVOS organizational claim coding, Medgate/Cority Number, and the Injured Worker’s Employee Clock Number are timely and accurately updated in IVOS to support data sharing requirements with Toyota/MTMUS.

Timely/ appropriately reports WC cases to the Claims Manager that will require Reserve Consultation Review at required thresholds with the Customer (arising reserves and reserve increases), to ensure compliance with Special Claim Handling requirements by plant affiliate location.

Is fully complaint in completing WC Claim Summaries on assigned cases as required and is a capable presenter in scheduled virtual meetings with Toyota, MTMUS, TMNA and Aon LA.

Manages, controls and negotiates timely and equitable claims payments and settlements in accordance with jurisdictional and fair claims practices requirements and Company policy and Special Claim Handling requirements.

Maintains diary and ensures appropriate 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 potential. Performs all necessary recovery activities.

Reports to Claims Manager regarding all new and continuing developments on claims being reportable to MSMM Home Office under published guidelines.

Ensures compliance with all adjuster licensing regulations and requirements.

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.

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.

Education and Experience Required:

High School Degree or G.E.D. is required. Bachelor's degree (B. A.) is preferred.

3+ years of claims experience, including ability to successfully negotiate settlements, verify coverage, appropriately set reserves, successfully complete investigations and understand rules associated with state regulations

It's an exciting time for our company and a great opportunity to join a financially sound and growing global insurance group!

It is the policy of MSIG USA to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, MSIG USA will provide reasonable accommodations for qualified individuals with disabilities.

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