Claim Specialist

MSIG USA•Atlanta, GA

About The Position

The Claim Specialist adjusts assigned claims within delegated authority, conducts timely and thorough investigations, handles subrogation claims, and completes fair and equitable settlements in accordance with MSMM Claim Handling Guidelines and applicable requirements for third-party administrator business. The role handles moderate to complex claim assignments and serves customers throughout the claims process.

Requirements

High school degree or GED required.
At least 5 years of claims experience.
Ability to negotiate settlements, verify coverage, set appropriate reserves, complete investigations, and understand state regulatory requirements.
Licensing in other states that would reciprocate to handling claims in West Virginia.

Nice To Haves

Bachelor's degree.
Litigation experience.

Responsibilities

Receive and analyze moderate to complex new claim assignments to determine the required investigation and handling.
Identify indemnity issues and coverage questions in accordance with claims guidelines and applicable principal requirements.
Conduct timely, thorough investigations, including arranging surveys as needed and complying with jurisdictional requirements.
Analyze cases and initiate reserve changes within assigned authority, making recommendations to a supervisor or manager when authority is exceeded.
Manage, control, and negotiate timely and equitable claim payments and settlements in accordance with applicable requirements and company policies.
Investigate, evaluate, and resolve moderate-level claim files.
Maintain current case diaries and appropriate hard-copy documentation, provide accurate claims-system records, and complete or submit required claim forms and reports.
Handle subrogation claims within delegated authority when required, including identifying responsible parties, preparing claim notices, corresponding with carriers, and negotiating settlements.
When required, assign lawsuits to approved defense counsel, direct and monitor counsel performance, comply with the Litigation Management Program, and review legal bills and expenses.
Serve the claim needs of insureds, claimants, brokers, and other customers, and attend client visits with underwriters and other parties for presentations and reviews.
Communicate with customers throughout the claims process to provide timely and appropriate claim status updates.
Complete accurate and timely data reports to state reporting agencies.
Comply with fair claims practices and applicable state and federal regulations.
Maintain state adjuster licenses and meet continuing education requirements.