Kalepa Insurance Services, LLC
Home Office Senior Claims Analyst & TPA Coord.
Kalepa Insurance Services, LLC, Atlanta, Georgia, United States, 30383
Home Office Senior Claims Analyst & TPA Coord. page is loaded## Home Office Senior Claims Analyst & TPA Coord.remote type:
Hybridlocations:
NJ-Warren:
GA-Atlanta:
IL-Chicago:
NY-NYC (Ave of Americas)time type:
Full timeposted on:
Posted Todayjob requisition id:
JR-000622MSIG USA continues to grow!**Company Overview:**is the US-based subsidiary of , 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:**The Sr. Claims Analyst & TPA Coordinator is responsible for assisting Home Office Claims Management with the oversight of the general liability,
auto liability, and management liability lines of business including the performance of claim technical audits.
Oversees SIR programs, bundled and unbundled TPA business including technical claim oversight.
Responsible for the handling of complex claims (coverage issues, high exposure severity claims). 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:*** Audit -- coordinate, schedule, select teams, produce final audit report and participate in the regular periodic audit of MSMM claims offices and units that handle, GL & AL and management liability claims.
Working with the office/unit manager, develop, implement and monitor corrective action plans resulting from these audits* TPA Management -- provide oversight and direction to TPA management and staff that handles claims on our behalf.
Also, evaluate the exposure to MSMM of claims that are handled by TPA’s and reported to MSMM (SIR or deductible accounts).* TPA Audit – coordinate, schedule, select teams and participate in the regular periodic audit of TPA’s, MGA’s and insurers that handle claims on or behalf or handle claims for our insured’s within their SIR/deductible.* Claim Handling Manuals – works with the Claims Operations department in coordinating and maintaining
updates to MSMM Claim Handling Manuals and Procedures Manuals for the AL, GL and management liability Lines of Business.
This includes TPA Claim Handling requirements.* TPA Management – works with the National Claims Operations, and Legal Department staff to coordinate and negotiate claim service agreements. This includes negotiation of all rates and fees; service standards; contracts and vendor performance.* Special Projects -- participates and/or manages special projects and assignments as needed.* Investigates, researches and analyzes moderate to highly complex or severe claims, including litigation, coverage issues and legal issues affecting liability and damages.* Is accountable for establishing and authorizing timely and adequate case reserves within delegated reserve/settlement authority and provides appropriate recommendations to Senior Management where reserve evaluation exceeds delegated authority.* Attends pre-trials, trials, settlement conferences, mediations, arbitrations and other meetings on assigned cases as required* Assigns lawsuits to approved defense counsel; directs and monitors quality and performance of approved defense counsel.
Maintains compliance with all requirements of the company’s Litigation Management Program. Review and adjusts, where appropriate, fee bills and legal expenses for accuracy and reasonableness.* Maintains regular reporting of case status, developments and direction to Home Office staff, MSI Japan, Reinsurers and other appropriate parties as necessary. Ensures appropriate hard copy file reports and system documentation as required by company claim manuals and procedures.**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:*** Bachelor's degree is preferred* 7+
years experience handling complex liability claimsIt's an exciting time for our company and a great opportunity to join a financially sound and growing global insurance group!It is the policy of MSIG USA to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, MSIG USA will provide reasonable accommodations for qualified individuals with disabilities.### Invest in Your Future With UsEach employee plays an important role which contributes directly to the success and continued growth of MSIG.MSIG Holdings (U.S.A.), Inc. (MSIG) 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.MSIG in the U.S. is comprised of three insurance companies with licenses in all fifty states as well as Puerto Rico and the District of Columbia. These companies and five other subsidiaries, deliver state of the art risk financing programs, insurance products, risk engineering and claims management services that enable our clients to effectively and efficiently manage their risks. Our insurance companies share the A.M Best’s A+ XV Rating and Standard & Poor’s A+ Rating of our Japan-based parent.Our clientele runs the gamut from small and mid-sized, sole-proprietorships, partnerships and corporations, up to some of the largest and most sophisticated multinational corporations operating in the U.S. and globally.The vast majority of clients seek our support related to Commercial Lines insurance products including Commercial Property and Liability Insurance products. However, through our subsidiary – Seven Hills Insurance Agency, LLC. – we are able to provide Personal Lines Insurance products including homeowners, renters, automobile, etc.**Specialties:**All Risk Property, Commercial Liability, Automobile, Workers Compensation, Management Liability, Marine, Excess & Umbrella, Claims Management, Risk Engineering services, etc. #J-18808-Ljbffr
Hybridlocations:
NJ-Warren:
GA-Atlanta:
IL-Chicago:
NY-NYC (Ave of Americas)time type:
Full timeposted on:
Posted Todayjob requisition id:
JR-000622MSIG USA continues to grow!**Company Overview:**is the US-based subsidiary of , 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:**The Sr. Claims Analyst & TPA Coordinator is responsible for assisting Home Office Claims Management with the oversight of the general liability,
auto liability, and management liability lines of business including the performance of claim technical audits.
Oversees SIR programs, bundled and unbundled TPA business including technical claim oversight.
Responsible for the handling of complex claims (coverage issues, high exposure severity claims). 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:*** Audit -- coordinate, schedule, select teams, produce final audit report and participate in the regular periodic audit of MSMM claims offices and units that handle, GL & AL and management liability claims.
Working with the office/unit manager, develop, implement and monitor corrective action plans resulting from these audits* TPA Management -- provide oversight and direction to TPA management and staff that handles claims on our behalf.
Also, evaluate the exposure to MSMM of claims that are handled by TPA’s and reported to MSMM (SIR or deductible accounts).* TPA Audit – coordinate, schedule, select teams and participate in the regular periodic audit of TPA’s, MGA’s and insurers that handle claims on or behalf or handle claims for our insured’s within their SIR/deductible.* Claim Handling Manuals – works with the Claims Operations department in coordinating and maintaining
updates to MSMM Claim Handling Manuals and Procedures Manuals for the AL, GL and management liability Lines of Business.
This includes TPA Claim Handling requirements.* TPA Management – works with the National Claims Operations, and Legal Department staff to coordinate and negotiate claim service agreements. This includes negotiation of all rates and fees; service standards; contracts and vendor performance.* Special Projects -- participates and/or manages special projects and assignments as needed.* Investigates, researches and analyzes moderate to highly complex or severe claims, including litigation, coverage issues and legal issues affecting liability and damages.* Is accountable for establishing and authorizing timely and adequate case reserves within delegated reserve/settlement authority and provides appropriate recommendations to Senior Management where reserve evaluation exceeds delegated authority.* Attends pre-trials, trials, settlement conferences, mediations, arbitrations and other meetings on assigned cases as required* Assigns lawsuits to approved defense counsel; directs and monitors quality and performance of approved defense counsel.
Maintains compliance with all requirements of the company’s Litigation Management Program. Review and adjusts, where appropriate, fee bills and legal expenses for accuracy and reasonableness.* Maintains regular reporting of case status, developments and direction to Home Office staff, MSI Japan, Reinsurers and other appropriate parties as necessary. Ensures appropriate hard copy file reports and system documentation as required by company claim manuals and procedures.**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:*** Bachelor's degree is preferred* 7+
years experience handling complex liability claimsIt's an exciting time for our company and a great opportunity to join a financially sound and growing global insurance group!It is the policy of MSIG USA to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, MSIG USA will provide reasonable accommodations for qualified individuals with disabilities.### Invest in Your Future With UsEach employee plays an important role which contributes directly to the success and continued growth of MSIG.MSIG Holdings (U.S.A.), Inc. (MSIG) 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.MSIG in the U.S. is comprised of three insurance companies with licenses in all fifty states as well as Puerto Rico and the District of Columbia. These companies and five other subsidiaries, deliver state of the art risk financing programs, insurance products, risk engineering and claims management services that enable our clients to effectively and efficiently manage their risks. Our insurance companies share the A.M Best’s A+ XV Rating and Standard & Poor’s A+ Rating of our Japan-based parent.Our clientele runs the gamut from small and mid-sized, sole-proprietorships, partnerships and corporations, up to some of the largest and most sophisticated multinational corporations operating in the U.S. and globally.The vast majority of clients seek our support related to Commercial Lines insurance products including Commercial Property and Liability Insurance products. However, through our subsidiary – Seven Hills Insurance Agency, LLC. – we are able to provide Personal Lines Insurance products including homeowners, renters, automobile, etc.**Specialties:**All Risk Property, Commercial Liability, Automobile, Workers Compensation, Management Liability, Marine, Excess & Umbrella, Claims Management, Risk Engineering services, etc. #J-18808-Ljbffr