Workers Compensation Claims Manager

Company Overview

MSIG North America is a wholly owned subsidiary of the MS & AD Insurance Group Holdings, Inc. - one of the top ten property-casualty insurance groups world-wide. Our Group has capital in excess of $25 Billion, operations in more than 40 countries and nearly 40,000 personnel located globally.

Position Overview

Provide oversight and technical advisement for all workers' compensation claims Responsible for the direct oversight of coverage and/or compensability issues to ensure timely recognition and referral in full compliance with MSMM Reporting Guidelines. Ensures compliance with all MSMM claim handling procedures, guidelines and manuals and other special unit procedures, as developed. Provides timely claim handling and service, timely compliance with case reserve practices, Fair Claim Practices Acts, and other compliance policies as adopted by MSMM.

Essential Functions: Percentage of Time:

Operational

• Review and assign all new loss notices to ensure the timely assignment of new claims to the appropriate claims staff.
• Manage and direct activities of claim representatives to ensure full compliance with MSMM Claim Handling Guidelines and jurisdictional requirements.
• Manage open claim files, including completion of supervisory diary to ensure adequacy of investigation, case reserving, evaluation, and reporting.
• Manage expenses in accordance with claims handling procedures. Ensure Home Office Claim Staff is timely informed of all new and continuing developments on claims being reportable under published guidelines.
• Monitor and maintain required licensing and certification/designation as stipulated by respective state agencies.
• Meets with Toyota Safety daily to discuss new WC claims, as well as updates on existing complex cases.
• Participation in regularly scheduled Claim & Litigation Review Meetings with TMMI, Toyota Headquarters-TMNA, and Aon LA (Broker).
• Participation in WC Trend Review Meetings and regularly scheduled Stewardship Meetings with TMMI, TMNA, and Aon LA.
• Responsible for overseeing "go and see" activity on disputed WC cases, which includes reviewing the job process on the Production floor.

Quality Control

• Provide technical and managerial oversight to the assigned staff by encouraging the timely, professional and appropriate handling of all reported claims in accordance with applicable contract provisions, legal regulations and guidelines, and company claim handling policies and procedures.
• Ensure compliance of Laserfiche file documentation and claim system documentation as required by company claim manuals and procedures.
• Conduct and register formal quality assurance audits for all assigned staff in the appropriate audit database to track compliance with MSMM Claims Handling and Regulatory requirements.
• Complete documented reviews of all open workers' compensation indemnity claims every 10, and subsequent 45-60 days to ensure timely and appropriate disposition of all reported claims.
• Ensure all medical only claims are reviewed per Company and Toyota Special Claim Handling Requirements, and subsequently every 30 days thereafter.
• Participate in the preparation and approval of agreed litigation plans. Direct and monitor litigated matters to determine future course of handling and appropriate methods of resolution.
• Participate in Home Office audits and/ monthly claim reviews to ensure compliance to Company Claim Handling Guidelines.

Employee Development

• Direct, guide and develop staff, including providing ongoing performance feedback and coaching to maximize individual contributions to achieve desired business results within the department and company.
• Communicate to assigned claims staff information regarding policy, plans, trends, results and objectives of the company and industry to ensure a proactive approach towards full participation and compliance with internal and industry standards.
• Develop, implement and monitor claim staff training to ensure compliance with continuing education requirements as well as established business and career development goals.

Customer Service

• 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.
• Organize and/or participate in on-site and teleconference claim reviews, client visits, and service presentations as required.
• Proficient in utilizing Risk Console and assisting the customers in use of tool, as well as understanding of the reports in the RMIS tool. Includes participation in monthly meetings with the customer to discuss WC trends and proposed counter-measures to reduce WC losses.

Additional projects as assigned.

Supervisory Responsibilities:

Responsible for providing leadership and maintaining an enthusiastic and appropriately trained claims staff ensuring they have appropriate knowledge and skill set while adhering to regulatory requirements and Company Claims Practices, Policies and Procedures.

Directly supervises 4 non-supervisory employees and 1 claim supervisor. Carries out management responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Delegates work assignments; Matches the responsibilities to the staff's knowledge and expertise; Gives authority to work independently; Sets expectations and monitors delegated activities; Provides appropriate structure for career development and prove recognition for results

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

• Bachelor's degree (B. A.) from four-year college or university
• 7+ years related claims experience including 5+ years at a management / supervisory level
• Advanced claim technical training
• Proven leadership ability at the field management level
• Excellent verbal and written communication skills
• Effective interpersonal skills and superior problem solving and decision making skills

The Company is an Equal Opportunity / Affirmative Action employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.