Claims Specialist - Construction

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 regulations
• Documents conversations within the claim files in a timely manner utilizing the appropriate level of detail and professional writing skills
• 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
• Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available
• 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
• Prepares statistical summaries, evaluations and reports, oral presentations to provide information and/or documenting activities
• Maintains claims files and records to document actions and ensuring compliance with participating policies and mandated legal requirements
• 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
• Interacts and communicates effectively with claimants, customers, health care providers, attorneys, brokers, and family members during the Claim Specialist’s claim evaluation
• 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
• Attends legal hearings, settlement conferences, mediations (e.g. meets with defense counselors, district defendants, settlement conferences, mediations, etc.) to provide testimony and monitoring proceedings
• 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
• Addresses and resolves escalated customer complaints in a timely and thorough manner
• Compiles file documentation and correspondence requiring extensive policy analysis and factual detail
• 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
• Evaluates auto and general liability claims to establish eligibility and course of action
• 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
• Identifies offsets and proficiently calculates monthly benefits due after elimination period, to include COLA, Social Security Offsets, Residual Disability, and non-routine payments
• Analyzes liability exposure for branches (e.g. Claims, etc.) to ensure correct action will take place
• Identifies, clarifies, and reconciles inconsistencies when gathering information during claim evaluations and collaborates with underwriting and Fraud Waste and Abuse resources as needed

Education and/ or Experience

• Bachelor's degree or a combination of education and related experience
• Ability to effectively manage multiple systems and technology sources
• Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively
• Must have a valid Driver's license and acceptable driving record
• 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
• Display superior written, oral communication skills and effective listening skills
• Knowledge of Microsoft Outlook, Word, and Excel
• Prior experience with independent judgement, critical thinking and decision making
• Prior experience working on damages and investigative work in support of contractual disputes, claims, and litigation
• 7+ years of Workers’ Compensation, liability, property, auto, general liability claims handling experience required
• Strong analytical skills with numbers
• 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
• Multi-jurisdictional understanding of legal issues
• Excellent customer service skills proven through internal and external customer interactions

• Health, Dental, and Vision as well as other supplemental health insurance.
• 401K Retirement Benefits are extended
• Holiday Pay
• On the job training provided to all employees
• 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.
• Opportunities for career advancement