Claims Specialist

PRS Holdings (Pavement Recycling Systems) needs a Claims Specialist at its Jurupa Valley, CA HQ to own liability, property, auto, general liability, and employment claims end to end — evaluation, adjudication, litigation support, and file documentation — for a construction/infrastructure company operating across the Western U.S. Salary range is $85K–$115K.

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

Must-haves

1. 7+ years handling Workers' Comp, liability, property, auto, and GL claims

2. Multi-jurisdictional / multi-state regulatory fluency

3. Bachelor's degree or equivalent combination of education and experience

4. Comfortable attending mediations, settlement conferences, and legal hearings

5. Valid driver's license with a clean record

Strong differentiator: construction industry claims experience — candidates who already understand equipment, jobsite, and auto exposure in paving/heavy civil work will ramp fastest.

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