Claims Adjuster - Workers' Compensation

Kalepa; Georgetown, Northern (KY, KY); Hybrid; USD 70,000 - 100,000; Full time

Job summary

MSIG USA is seeking a claims adjuster to handle moderate to complex claims, conduct thorough investigations, determine coverage, and manage reserves and settlements within authority. The role emphasizes timely communication with clients and adherence to company guidelines and statutory requirements.

Preferred candidates have 5+ years of claims experience, a high school diploma or GED, and a Bachelor's degree preferred.

Qualifications

• 5+ years of claims experience.
• Experience negotiating settlements and setting reserves.
• Knowledge of state regulations and regulatory compliance.

Responsibilities

• Receive and analyze new claim assignments of moderate to complex nature.
• Investigate and assess coverage and indemnity issues.
• Manage claims diary, reserves, and settlements within authority.
• Coordinate with defense counsel and subrogation where applicable.
• Ensure timely data reporting and regulatory compliance.

Skills

Negotiation

Investigation

Case management

Education

High school diploma or GED

Bachelor's degree preferred

Job description

Company Overview:

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.

MSIG Holdings (U.S.A.), 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. MSIG in the U.S. is comprised of three insurance companies with licenses in all fifty states as well as Puerto Rico and the District of Columbia. These companies and five other subsidiaries, deliver state of the art risk financing programs, insurance products, risk engineering and claims management services that enable our clients to effectively and efficiently manage their risks. Our insurance companies share the A.M Best’s A+ XV Rating and Standard & Poor’s A+ Rating of our Japan-based parent. Our clientele runs the gamut from small and mid-sized, sole-proprietorships, partnerships and corporations, up to some of the largest and most sophisticated multinational corporations operating in the U.S. and globally. The vast majority of clients seek our support related to Commercial Lines insurance products including Commercial Property and Liability Insurance products. However, through our subsidiary – Seven Hills Insurance Agency, LLC. – we are able to provide Personal Lines Insurance products including homeowners, renters, automobile, etc. Specialties: All Risk Property, Commercial Liability, Automobile, Workers Compensation, Management Liability, Marine, Excess & Umbrella, Claims Management, Risk Engineering services, etc.

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 and/or requirements of principals regarding TPA business to ensure services are provided in a fair, equitable and timely manner.

Essential Functions:

• Receives new claim assignments of a moderate to complex nature and analyzes the nature of the claim to determine required investigation and handling.
• Determines and identifies indemnity issues or questions of coverage in accordance with MSMM Claims Handling Guidelines and/or requirements of principals regarding TPA business.
• Performs timely and thorough investigations including necessary survey arrangement in compliance with all jurisdictional requirements and/or entitlements.
• Conducts an informed case analysis to initiate reserve changes within assigned authority and makes recommendations to supervisor or manager where assigned authority is exceeded.
• Manages, controls and negotiates timely and equitable claim payments and settlements in accordance with jurisdictional and fair claims practice requirements and company policy and procedures.
• Investigates, evaluates and resolves moderate level claims files.
• Maintains current case diary and ensures retention of appropriate hard copy file documentation.
• Provides 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.
• May handle subrogation of claims within delegated limits of authority, including identification of responsible parties, preparation of claim notice, correspondence with carriers, and negotiation of settlement in accordance with MSMM Recovery Procedures.
• May be required to assign 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.
• 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.

Supervisory Responsibilities:

This position has no supervisory responsibilities.

Qualifications:

• Education and Experience Required: Diploma/Degree & Experience High School Degree or G.E.D. is required.
• Bachelor's degree (B. A.) is preferred.
• 5+ 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.
• New York or Virginia claims handling experience is preferred.

EEO / Equality Statement:

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. Each employee plays an important role which contributes directly to the success and continued growth of MSIG.