Summary/Job Purpose:

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.

Essential Functions:

Percentage of Time:

• 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.

Supervisory Responsibilities:

This position has no supervisory responsibilities.

Qualifications:  To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and Experience Required: 

Diploma/Degree & Experience

• High School Degree or G.E.D. is required. Bachelor's degree (B. A.) is preferred.
• 5+ years of claims experience, including ability to successfully negotiate settlements, verify coverage, appropriately set reserves, successfully complete investigations and understand rules associated with state regulations
• New York or Virginia claims handling experience is preferred. 

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Salary: The base pay range is 95k-105k . Salary determinations are based on various factors, including but not limited to, relevant work experience, skills, certifications and location.

Additional Benefits:  

• Healthcare and Retirement Benefits
• Comprehensive medical, dental, and vision coverage
• 401(k) with a generous employer match and profit-sharing contribution
• Wellness incentive program
• Life and accidental death and dismemberment (AD&D) insurance
• Flexible spending programs
• Short-term and long-term disability plans

Additional Benefit Programs

• Paid time off program
• Paid charitable leave
• Paid parental leave
• Tuition reimbursement program
• Personal insurance (auto/homeowners) discounts

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