Claims Adjuster - Workers' Compensation

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-proprietor ships, 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.

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.

• 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…