Claims Adjuster - Workers' Compensation

MSIG USA•Georgetown, KY

23h

About The Position

The Claims Adjuster is responsible for adjusting assigned workers' compensation claims within delegated authority, conducting timely and thorough investigations, handling subrogation claims, and completing fair and equitable settlements in accordance with MSMM Claim Handling Guidelines and applicable requirements for TPA business. The role investigates and resolves moderate-level claims, evaluates indemnity and coverage issues, manages reserves, and negotiates claim payments and settlements in compliance with jurisdictional requirements, fair claims practices, and company procedures. The position maintains claim diaries, documentation, and accurate claims-system records; submits required forms and reports to outside and state agencies; and may coordinate defense counsel and monitor litigation activities. It also provides ongoing claim service and status communications to insureds, claimants, brokers, and other customers, and may attend client visits with underwriters and other parties. The role requires compliance with applicable regulations, licensing requirements, and continuing education requirements. There are no supervisory responsibilities.

Requirements

High school diploma or GED.
At least 5 years of claims experience.
Ability to negotiate settlements, verify coverage, set appropriate reserves, complete investigations successfully, and understand state regulatory rules.

Nice To Haves

Bachelor's degree.
New York or Virginia claims-handling experience.

Responsibilities

Receive and analyze assigned moderate-to-complex claims to determine the required investigation and handling, and identify indemnity issues or coverage questions.
Conduct timely and thorough investigations, including arranging surveys when necessary, in compliance with jurisdictional requirements and entitlements.
Analyze cases, initiate reserve changes within assigned authority, and make recommendations to a supervisor or manager when authority is exceeded.
Manage, control, and negotiate timely and equitable claim payments and settlements in accordance with jurisdictional and fair claims practice requirements and company policies.
Investigate, evaluate, and resolve moderate-level claims files.
Maintain current case diaries, appropriate hard-copy files, and accurate claims-system documentation.
Complete or submit claim forms and reports required by outside agencies.
Handle subrogation claims within delegated authority when assigned, including identifying responsible parties, preparing claim notices, corresponding with carriers, and negotiating settlements.
Assign lawsuits to approved defense counsel when required, direct and monitor counsel's quality and performance, and comply with the Litigation Management Program.
Review and adjust defense counsel fee bills and legal expenses for accuracy and reasonableness when appropriate.
Serve customers, including insureds, claimants, and brokers, in accordance with company policies and procedures, and attend client visits with underwriters and others to conduct presentations and reviews.
Maintain ongoing customer communication throughout the claims process and provide timely, appropriate claim status updates as required.
Complete timely and accurate data reports to state reporting agencies.
Comply with applicable fair claims practices acts and state and federal regulations.
Maintain state adjuster licenses and meet continuing education requirements.