Sr. Claims Representative (Auto Liability)

Company Overview:

Mitsui Sumitomo Marine Management U.S.A., Inc. is one of the world’s top ten property/casualty insurance carriers with over 40,000 employees worldwide.

Position Overview:

This position is responsible for the adjustment of assigned Auto Liability, Med Pay, and PIP claims with exposures up to $250,000.  The adjuster in this position is required to conduct thorough investigations, evaluations, and negotiations of moderate to complex claims including litigation and coverage issues.  The adjuster is accountable for ensuring compliance with MSMM Claim Handling Guidelines, including reserving and payment practices, regulatory requirements and Fair Claims Practices Acts.

Essential Functions: 

Claims Handling                                                                                                                                       60%

• Receives new Auto Liability, Med Pay, and PIP claim assignments with exposures up to $250,000. Analyzes the nature of the claim to determine the required investigation and handling.
• Investigates, researches and analyzes moderate to complex severity claims, including coverage issues and legal issues affecting liability and damages.
• Establishes appropriate case reserves, completes settlements and case resolutions within established reserve and settlement authorities. Recommends reserve and settlement values on assigned cases in excess of established reserve and settlement authority.
• Manages, controls and negotiates timely and equitable claim payments and settlements in accordance with jurisdictional and fair claim practices and company policy and procedures.
• Maintains current case diary and provides accurate claims system documentation as required by company claim manuals and procedures. Responsible for completion and/or submission of claim and statutory reports as required.
• Attends pre-trials, trials, settlement conferences and mediations on assigned cases as required
• Assigns 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.

Customer Service                                                                                                                                  20%

• 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.

Regulatory and Operational Compliance                                                                                        20%

• Completes timely and accurate data reports to state reporting agencies to ensure full compliance with MSMM and regulatory requirements.
• 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.
• Maintains regular reporting of case status, developments and direction to Home Office staff and other appropriate parties as necessary. Ensures timely and appropriate file reports and system documentation as required by company claim manuals and procedures.
• Participates and/or manages special projects and assignments as needed.

Supervisory Responsibilities:

This position has no supervisory responsibilities.

Education & Experience:

• High School Degree or G.E.D. is required. Bachelor’s degree preferred
• 7+ years related experience handling auto liability, med pay, and pip claims.

If you would like to apply for this position please send your resume to resumes@msigusa.com

The Company is an Equal Opportunity / Affirmative Action employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.

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