Claim Specialist

MSIG Holdings•Atlanta, MN

About The Position

MSIG USA is the U.S.-based subsidiary of MS&AD Insurance Group Holdings, Inc., a global property and casualty insurer with operations in more than 40 countries and regions. 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, for third-party administrator business, principal requirements. The role handles moderate to complex claim assignments, evaluates coverage and indemnity issues, establishes and recommends reserves, negotiates settlements, maintains claim records and system documentation, and provides ongoing service and status communication to customers. It may also involve assigning and monitoring defense counsel, reviewing legal expenses, attending client visits, and ensuring compliance with applicable claims, licensing, and regulatory requirements.

Requirements

High school degree or GED.
At least 5 years of claims experience.
Ability to negotiate settlements, verify coverage, appropriately set reserves, conduct investigations, and understand state regulatory requirements.
Maintain compliance with applicable state adjuster licensing and continuing education requirements.

Nice To Haves

Bachelor’s degree.
Litigation experience.
Licensing in other states that would reciprocate to handling claims in West Virginia.

Responsibilities

Receive and analyze moderate to complex claim assignments to determine appropriate investigation and handling.
Identify indemnity issues and coverage questions in accordance with claims guidelines and applicable principal requirements.
Conduct timely and thorough investigations, including arranging surveys when necessary, while meeting jurisdictional requirements.
Analyze cases, initiate reserve changes within delegated authority, and make recommendations when authority limits are exceeded.
Manage, control, and negotiate timely and equitable claim payments and settlements in accordance with applicable law, company policy, and fair claims practices.
Investigate, evaluate, and resolve moderate-level claim files.
Maintain current case diaries and appropriate hard-copy file documentation, and enter accurate claim-system documentation.
Complete or submit claim forms and reports required by outside agencies.
Handle subrogation claims within delegated authority as applicable, including identifying responsible parties, preparing notices, corresponding with carriers, and negotiating settlements.
Assign defense of lawsuits to approved counsel when required, and direct and monitor counsel’s quality and performance.
Comply with the company’s Litigation Management Program and review fee bills and legal expenses for accuracy and reasonableness.
Serve insureds, claimants, brokers, and other customers in accordance with company procedures; attend client visits with underwriters and other parties for presentations and reviews.
Maintain ongoing customer communication and provide timely, appropriate claim status updates as required.
Complete accurate and timely reports to state agencies and comply with fair claims practices laws and state and federal regulations.
Maintain state adjuster licenses and meet continuing education requirements.