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Examiner OTAI LA

Job ID: 1007956
Date Posted: Oct 5, 2022
Department ID: 206400
Company: TM Claims Service Inc.

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Job Description

Marketing Statement

TM Claims Service (TMCS) is an independent global claims management firm established in 1987 to provide clients with a broad range of claims-related services in the areas of transportation, product liability and overseas travel accident insurance. As part of the Tokio Marine Group of companies TM Claims Service provides claims handling services throughout the US and the Americas. Founded in 1879, Tokio Marine is recognized as Japan’s oldest insurer and one of the largest insurance groups in the world. Tokio Marine has offices in 38 countries staffed by more than 15,000 employees outside of Japan.

Duties

Job Summary:

Handle OTAI claims including complex cases and coordinate other OTAI related matters, and undertake special projects as assigned by Manager.

Essential Job Functions:

  1. Receive notice of OTAI claims in Japanese and English from policyholders, insureds, medical providers, or other parties.  Provide necessary explanations and instructions to those parties.
  2. Review OTAI claim documents presented by policyholders, medical providers, or other parties.
  3. Review and determine coverage and evaluate the amount of loss being claimed.
  4. Negotiate and settle claims including complex cases in Japanese and English with various parties concerned.
  5. Process claims in the OTAI system and issue Statements of Claim.
  6. Communicate with TMNF-OTAI and other organizations to verify coverage and confer on handling.
  7. Coordinate OTAI claims with other claim agents as necessary. 
  8. Collaborate with claim assistants in managing clerical aspects of OTAI claims handling.
  9. Responsible for complying with proper internal controls as necessary to conduct job functions and/or carry out responsibilities and/or administrative activities at Company.     

Qualifications

Qualifications:

-     Bilingual in Japanese and English required

-     College degree preferred

-     Good verbal and written communication skills

-     Basic knowledge of insurance

-     Knowledge of medical terms and codes desirable

-     Two or three years of related work experience preferable

-     Proficient PC skills in Microsoft Word and Excel

-     Ability to work as a team member

EEO Statement

Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer.  In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status,  sexual orientation and/or any other status protected by law. 

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