Claims Specialist

Primary Responsibilities

• 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
  • Construction experience preferred
  • 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

  Benefits

  • 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 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

  Pay

  USD $85,000.00 - USD $115,000.00 /Yr.

  Schedule

  N/A