Claims Coordinator (Bilingual - Japanese)

Company Overview:

Mitsui Sumitomo Marine Management U.S.A., Inc. is one of the world’s top ten property/casualty insurance carriers with over 40,000 employees worldwide.

Position Overview:

To adjust assigned Overseas Travel Accident Insurance (OTAI) claims within delegated limits of authority, conduct timely and thorough investigations and complete fair and equitable claim settlements in accordance with MSIJ and MSMM Claim Handling Guidelines that will ensure services are provided in a fair, equitable and timely manner.

Essential Functions:

• Upon receipt of new claim assignments; analyze the nature of the claim to identify and determine coverage and thoroughly evaluate questions of compensability, to include required investigation and handling in accordance with the MSIJ requirements and/ MSMM Claims Handling Guidelines.
• Performs timely and thorough investigations in an effort to comply with all jurisdictional requirements and/or entitlements.
• Conducts an informed case analysis to address claim entitlements, initiate reserve changes within assigned authority, provide 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.
• Maintains current case diary and ensures appropriate file documentation.
• Provides accurate claim system documentation and paperless file 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.
• Investigates and evaluates recovery potential. Conducts timely and thorough subrogation investigation in accordance with company policy and procedures. Timely handling and referral of all claims involving recovery potential.
• Provide exceptional customer service to our customers, to include prompt responses to the insured’s, claimants, medical providers, etc. in accordance with company policy and procedures.
• Partner with internal and external customers to bring about an appropriate claim resolution in a timely and effective manner in accordance with MSIJ and MSMM Claims handling Guidelines

Education & Experience:

• Bachelor's degree (B. A.) from four-year college or university is preferred.
• High School Degree or G.E.D. is required.
• Prior experience handling health insurance or other medical claims a plus. Knowledge of medical terminology.
• Must be Fluent in Japanese.

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.