Claims Specialist

Company: PRS Holdings Inc.
Location: Mira Loma
Posted on: February 1, 2025

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
Performs other duties as assigned

Qualifications

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
Ability to effectively manage multiple systems and technology sources

Education and/ or Experience

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
Multi-jurisdictional understanding of legal issues

Why Join

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
Work for an industry leader in various disciplines and markets

Physical Requirements
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
The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus

We are an equal opportunity employer and give consideration for employment to qualified applicants without regard to age, race, color, religion, creed, sex, sexual orientation, gender identity or expression, national origin, marital status, disability or protected veteran status, or any other status or characteristic protected by federal, state, or local law.Compensation details: 80000-100000 Yearly SalaryPI24190518d82e-25660-34902736

Keywords: PRS Holdings Inc., Costa Mesa , Claims Specialist, Other , Mira Loma, California