What are the responsibilities and job description for the Workers Compensation - Claims Representative - Medical Only position at MSIG North America?
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, 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 medical only workers’ compensation claim assignments of minor to moderate complexity level. Analyzes the nature of the claim to determine required investigation and handling. Determines and identifies compensablity issues or questions of coverage in accordance with MSMM Claims Handling Guidelines.
- Performs timely and thorough investigations 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.
- 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.
- 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:
Diploma/Degree & Experience
- High School Degree or G.E.D. is required. Bachelor's degree (B. A.) from four-year college or university is preferred.
- 2 years of industry experience, including ability to successfully verify coverage, appropriately establish reserves, 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.
