Workers Compensation - Claims Representative - Medical Only

MSIG USA continues to grow! 

Company Overview:

MSIG USA is the US-based subsidiary of MS&AD Insurance Group Holdings, Inc., one of the world’s top P&C carriers and a global Class 15 insurer, with A+ ratings and a reach that spans 40+ countries and regions. Leveraging our 350-year heritage, MSIG USA brings the financial strength, expertise, and global footprint to offer commercial insurance solutions that address your business’s unique risks.

Summary/Job Purpose:

This position is responsible to adjust assigned claims within delegated limits of authority, conduct timely and thorough investigations, 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.

Essential Functions:

Percentage of Time:

• Receives new medical only workers’ compensation claim assignments of minor to moderate complexity level. Analyzes the nature of the claim to determine required investigation and handling.  Determines and identifies compensablity issues or questions of coverage in accordance with MSMM Claims Handling Guidelines.

• Performs timely and thorough investigations 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.

• 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.