Senior Claims Specialist, Workers Compensation

Tokio Marine Group•Pasadena, CA

About The Position

Tokio Marine has been conducting business in the U.S. market for over a century and we are licensed in all states, Puerto Rico and the District of Columbia, and write all major lines of Commercial Property and Casualty Insurance. We provide unique insurance and risk management tools from our experienced staff of account executives, underwriters and loss prevention engineers and fair and timely claim settlement from a skilled team of claim professionals. We work with major brokers and leading independent insurance agents throughout the United States to serve the world's largest and most distinguished organizations. We are committed to creating value for our customers by providing ANSHIN (safety, security and peace of mind). We strive to be creative and passionate as we work towards our long-term success. Tokio Marine Holdings is Japan's oldest, and one of the largest property and casualty insurers. Founded in 1879, TMNF operates worldwide in 47 countries. With annual revenues of approximately $50 billion and an A.M. Best rating of A++, one of the highest in the industry, we are one of the top 20 insurance providers worldwide. Process Workers Compensation Medical and Indemnity Claims, monitor Workers Compensation cases and direct attorney and outside vendors assigned to these claims.

Requirements

Must have applicable state licensing or the ability to obtain.
Knowledge of Workers' Compensation policy coverages
Knowledge of coding related to claims technical matters
Knowledge of legal, medical terms and meanings, civil and agency laws and related fields which may come within the purview of Workers' Compensation claims
Ability to negotiate settlement/resolution of claims in a timely and reasonable fashion
Proficient in Microsoft office
Good oral and written communication skills

Nice To Haves

College Degree Preferred
5 to 10 years of experience handling Workers' Compensation claims for a major insurance carrier

Responsibilities

Confirm coverage and policy information.
Establish proper loss reserve, negotiate loss settlement (when applicable) and bring cases to resolution.
Maintain control of outside vendors/attorneys and their expenses by directing assignments to them and limiting their scope to maximize cost effectiveness while minimizing delays in claims handling.
Maintain compliance with Workers' Compensation procedure and requirements established by regulatory authorities.
Pursue Workers' Compensation liens and subrogation when appropriate.
Maintain compliance with claims practice rules and internal instructions.
Keep manager advised of significant developments in claims.
Answer correspondence and inquiries promptly from brokers/agents, insureds, claimants, doctors, attorneys, outside vendors, TMA employees, etc.
Responsible for complying with proper internal controls as necessary to conduct job functions and/or carry out responsibilities and/or administrative activities at Company.