Senior Claims Specialist

Waiting for Text from PRS Holding....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.Effectively evaluates, and manages liability, property, auto, general liability claims, and employment claims in compliance with state regulationsAdjudicates 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 statutesAnalyzes liability exposure for branches (e.g. Claims, ) to ensure correct action will take placeAttends legal hearings, settlement conferences, mediations (e.g. meets with defense counselors, district defendants, settlement conferences, mediations, etc.) to provide testimony and monitoring proceedingsEvaluates auto and general liability claims to establish eligibility and course of actionMaintains claims files and records to document actions and ensuring compliance with participating policies and mandated legal requirementsOversees the claims handling and third-party provider (e.g. litigation on complex cases ) to ensure the claims are being handled according to the legal regulations per statePrepares statistical summaries, evaluations and reports, oral presentations to provide information and/or documenting activitiesResponds 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 directionsProvides 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 regulationsServe 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 provisionsDocuments conversations within the claim files in a timely manner utilizing the appropriate level of detail and professional writing skillsInteracts and communicates effectively with claimants, customers, health care providers, attorneys, brokers, and family members during the Claim Specialist’s claim evaluationCompiles file documentation and correspondence requiring extensive policy analysis and factual detailAnalyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information availableCollaborates 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 thoroughIdentifies, clarifies, and reconciles inconsistencies when gathering information during claim evaluations and collaborates with underwriting and Fraud Waste and Abuse resources as neededIdentifies offsets and proficiently calculates monthly benefits due after elimination period, to include COLA, Social Security Offsets, Residual Disability, and non-routine paymentsAddresses and resolves escalated customer complaints in a timely and thorough mannerPerforms other duties as assignedProven time management and follow-through skills with the ability to work on multiple tasks with tight deadlinesHighly detail-oriented and excellent organizational skillsPrior experience with independent judgement, critical thinking and decision makingDisplay superior written, oral communication skills and effective listening skillsHighly motivated team player, with a demonstrated passion for excellence and taking the initiativeRegulationsDemonstrated conceptual thinking, risk management, ability to handle complex situations effectivelyExcellent customer service skills proven through internal and external customer interactionsStrong analytical skills with numbersKnowledge of Microsoft Outlook, Word, and ExcelAbility to effectively manage multiple systems and technology sourcesESOP 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 to all Non-union employees. Health, Dental, and Vision as well as other supplemental health insurance. PTO and Holiday Pay. Opportunities for career advancement. On the job training provided to all employees. Work for an industry leader in various disciplines and markets.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, 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 smellThe 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 focusUSD $90,000.00 - USD $100,000.00 /Yr.

Created: 2025-10-10