Overview

Claims SpecialistUS-CA-Jurupa ValleyJob ID: Type: Full-Time# of Openings: 1Category: Risk ManagementJurupa Valley - PCCOverview 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 deta