Senior Claims Adjuster (Workers Compensation)

MSIG Holdings•Huntsville, AL

2d•Hybrid

About The Position

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 appropriate, fee bills and legal expenses for accuracy and reasonableness. 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. Completes timely and accurate data reports to state reporting agencies to ensured full compliance with MSMM and regulatory requirement. 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.

Requirements

High School Degree or G.E.D. is required.
7+ years of claims experience.
Ability to successfully negotiate settlements.
Ability to verify coverage.
Ability to appropriately set reserves.
Ability to successfully complete investigations.
Understanding of rules associated with state regulations.

Nice To Haves

Bachelor's degree (B. A.) is preferred.

Responsibilities

Adjust assigned claims within delegated limits of authority.
Conduct timely and thorough investigations.
Handle subrogation claims.
Complete fair and equitable claim settlements.
Analyze the nature of the claim to determine required investigation and handling.
Determine and identify indemnity issues or questions of coverage.
Perform timely and thorough investigations including necessary survey arrangement.
Conduct an informed case analysis to initiate reserve changes within assigned authority.
Manage, control and negotiate timely and equitable claim payments and settlements.
Investigate, evaluate and resolve moderate level claims files.
Maintain current case diary and ensure retention of appropriate hard copy file documentation.
Provide accurate claims system documentation.
Complete and/or submit claim forms and reports as required by outside agencies.
Handle subrogation of claims within delegated limits of authority.
Assign the defense of lawsuits to approved defense counsel.
Direct and monitor quality and performance of defense counsel.
Review and adjust fee bills and legal expenses for accuracy and reasonableness.
Service the claim needs of customers including insureds, claimants, brokers, etc.
Attend client visitations with underwriters and other parties to conduct presentations and reviews.
Maintain ongoing communication with all customers throughout the claims process.
Complete timely and accurate data reports to state reporting agencies.
Maintain full compliance with all regulatory Fair Claim Practices Acts and state and federal regulations.
Maintain full compliance with all state licensing and continuing education requirements.