Claims Specialist
13 days ago
Mira Loma
Job Description Pavement Recycling Systems is the Western United States premier provider of Recycling Solutions to reclaim, preserve, and rehabilitate pavement at any stage. Becoming a team member of PRS introduces you to a unique culture of employee ownership and empowerment to grow and succeed in your career. We create an environment in which all employees develop and contribute to their full potential and we recognize and reward outstanding results. Position overview The Claims Specialist is responsible for evaluating, processing, and managing liability, property, auto, general liability claims, and employment claims in compliance with state regulations; documenting activities; conveying information regarding claims and/or benefits; and providing testimony in benefit disputes while exercising discretion, independent judgment, critical thinking skills and demonstrate exemplary customer services skills Primary Responsibilities • Effectively evaluates, and manages liability, property, auto, general liability claims, and employment claims in compliance with state regulations, • Adjudicates auto and general liability claims for Pavement Recycling Systems and all associated entities (e.g. determining validity, reaching closure, etc.) to comply with legal requirements and state statutes, • Analyzes liability exposure for branches (e.g. Claims, etc.) to ensure correct action will take place, • Attends legal hearings, settlement conferences, mediations (e.g. meets with defense counselors, district defendants, settlement conferences, mediations, etc.) to provide testimony and monitoring proceedings, • Evaluates auto and general liability claims to establish eligibility and course of action, • Maintains claims files and records to document actions and ensuring compliance with participating policies and mandated legal requirements, • Oversees the claims handling and third-party provider (e.g. litigation on complex cases etc.) to ensure the claims are being handled according to the legal regulations per state, • Prepares statistical summaries, evaluations and reports, oral presentations to provide information and/or documenting activities, • Responds to inquiries from claimant, participating district and/or and involved personnel (e.g. status of claim, subrogation activities, etc.) to resolve issues, facilitating communication among parties and/or providing information or directions, • Provides timely, balanced, and accurate claims reviews, documentation, and decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations, • Serve as the face of the company in providing frequent, proactive verbal communication with our claimants, customers and/or their representatives demonstrating empathy and active listening while providing clear updates, direction and explanations regarding the claim process, benefits, and other pertinent policy provisions, • Documents conversations within the claim files in a timely manner utilizing the appropriate level of detail and professional writing skills, • Interacts and communicates effectively with claimants, customers, health care providers, attorneys, brokers, and family members during the Claim Specialist’s claim evaluation, • Compiles file documentation and correspondence requiring extensive policy analysis and factual detail, • Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available, • Collaborates with both external and internal resources, such as physicians, attorneys, and vocational consultants to gather data such as medical/occupational information to ensure claim decisions are well-reasoned and thorough, • Identifies, clarifies, and reconciles inconsistencies when gathering information during claim evaluations and collaborates with underwriting and Fraud Waste and Abuse resources as needed, • Identifies offsets and proficiently calculates monthly benefits due after elimination period, to include COLA, Social Security Offsets, Residual Disability, and non-routine payments, • Addresses and resolves escalated customer complaints in a timely and thorough manner, • Proven time management and follow-through skills with the ability to work on multiple tasks with tight deadlines, • Highly detail-oriented and excellent organizational skills, • Prior experience with independent judgement, critical thinking and decision making, • Display superior written, oral communication skills and effective listening skills, • Highly motivated team player, with a demonstrated passion for excellence and taking the initiative, • Regulations, • Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively, • Excellent customer service skills proven through internal and external customer interactions, • Strong analytical skills with numbers, • Knowledge of Microsoft Outlook, Word, and Excel, • Bachelor's degree or a combination of education and related experience, • 7+ years of Workers’ Compensation, liability, property, auto, general liability claims handling experience required, • Prior experience working on damages and investigative work in support of contractual disputes, claims, and litigation, • Must have a valid Driver's license and acceptable driving record, • ESOP Retirement Benefits are extended to all employees with participation after one year of service. A typical discretionary annual company contribution can range from 10% to 15% of your annual salary., • 401K Retirement Benefits are extended, • Health, Dental, and Vision as well as other supplemental health insurance., • PTO, • Holiday Pay, • Opportunities for career advancement, • On the job training provided to all employees The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to: • While performing the duties of this job, the employee is regularly required to use hands to finger, handle, feel or operate objects, tools, or controls and reach with hands and arms. The employee frequently is required to stand, walk and talk or hear. The employee is regularly required to sit; climb or balance; stoop, kneel, crouch, or crawl; and smell Powered by ExactHire:187579
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