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Claims Specialist, Senior Workers Comp Claims Adjuster

Job ID: 1006781
Date Posted: Jun 1, 2021
Department ID: TM0604 Claims - WC - CSO
Company: Tokio Marine Management Inc.

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Job Description

Marketing Statement

About Tokio Marine:

Tokio Marine has been conducting business in the U.S. market for over a century and we are licensed to write all lines in 50 states, Puerto Rico and the District of Columbia. 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 38 countries. With annual revenues of approximately $18 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.

Duties

Job Summary

Responsible for initial claim receipt and complete setup, investigation, damage assessment, evaluation and resolution of claims. Accountable for proper payout and quality of claim files. 

Primary Job Duties

•     Establish and maintain a rapport with customer, injured party and medical provider to obtain information

•     Obtain all relevant facts to determine coverage, liability or compensability on claim files

•     Determine and analyze medical condition through investigation

•     Utilize and manage experts to determine facts, damages and exposure, ensuring the value of the service is greater than the cost

•     Work as a partner with defense counsel and ensure legal resources are used to obtain the best resolution on the claim

•     Monitor medical progress and utilize medical management for indemnity control

•     Evaluate information to assess proper resolution of claim and to determine appropriate and fair settlement

•     Negotiate settlement based upon strategies and plans that ensure appropriate fair settlement of the claim

•     Must have self-management skills to maintain and utilize all administrative functions of position

•     Recognize and implement LAE reductions techniques

•     Available for local and out-of-state travel to visit clients, maintain state licensing requirements

•     Responsible for complying with proper internal controls as necessary to conduct job functions and/or carry out responsibilities and/or administrative activities at Company. 

Other Functions

•     Ability to work as part of a team

•     Regular and reliable attendance

•     Perform other duties as may be assigned

EEO Statement

•     Bachelor's degree preferred

•     Three to five years Workers Compensation claims experience

•     Knowledge of a specific line of business: workers' compensation and subrogation

•     Ability to negotiate claims toward settlement and resolution

EEO Statement

Tokio Marine Management 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, or sexual orientation.

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