Senior Claims Adjuster - Workers' Compensation

Mitsui Sumitomo Insurance Group; Georgetown (KY); On-site; USD 95,000 - 105,000; Full time

Benefits offered by this job

Healthcare and Retirement Benefits

401(k) with employer match

Wellness incentive program

Life and AD&D insurance

Flexible spending programs

Disability plans

Paid time off

Tuition reimbursement

Job summary

MSIG USA in Kentucky, Georgetown, is seeking a Senior Claims Adjuster for Workers' Compensation. This role handles moderate to complex claims, conducts investigations, negotiates settlements, and reserves within delegated authority.

The position offers hybrid work, a base pay range of 95k–105k, comprehensive benefits, and growth opportunities within a global insurer. Prior NY/VA experience is preferred and licensure compliance is required.

Qualifications

• 5+ years of claims experience with settlements and reserves.
• Experience handling NY or VA claims preferred.
• Bachelor's degree preferred; high school required.

Responsibilities

• Receive and analyze new claim assignments to determine investigation needs.
• Identify indemnity issues or coverage questions per guidelines.
• Conduct timely investigations and arrange surveys as required.
• Adjust reserves within authority and recommend actions to supervisor.
• Manage payments and settlements in line with policy and laws.
• Maintain claim diary and documentation; prepare required reports.
• May handle subrogation and coordinate defense with counsel when needed.
• Ensure regulatory compliance and licensing requirements are met.

Skills

Negotiation

Investigations

Regulatory knowledge

Communication

Education

High School or GED

Bachelor's degree preferred

Job description

Senior Claims Adjuster - Workers' Compensation page is loaded## Senior Claims Adjuster - Workers' Compensationremote type: Hybridlocations: KY-Georgetowntime type: Full timeposted on: Posted Yesterdayjob requisition id: JR-000913MSIG USA continues to grow!**Company Overview:**is the US-based subsidiary of, 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 and/or requirements of principals regarding TPA business to ensure services are provided in a fair, equitable and timely manner.**Essential Functions:****Percentage of Time:*** 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:** To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.**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.#LI-HYBRIDSalary: The base pay range is 95k-105k. Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location.Additional Benefits:* Healthcare and Retirement Benefits* Comprehensive medical, dental, and vision coverage* 401(k) with a generous employer match and profit-sharing contribution* Wellness incentive program* Life and accidental death and dismemberment (AD&D) insurance* Flexible spending programs* Short-term and long-term disability plansAdditional Benefit Programs* Paid time off program* Paid charitable leave* Paid parental leave* Tuition reimbursement program* Personal insurance (auto/homeowners) discounts#LI-HYBRIDIt'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.### Invest in Your Future With UsEach employee plays an important role which contributes directly to the success and continued growth of MSIG.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.