Claims Analyst

Company Overview

PRS Holdings Inc. stands as a leading provider of innovative recycling solutions across the Western United States, dedicated to reclaiming, preserving, and rehabilitating pavement at every stage. Joining our team means becoming part of a unique culture that emphasizes employee ownership and empowerment, fostering an environment where all team members can thrive and achieve their career aspirations.

Position Summary

The Claims Analyst plays a crucial role in assessing, processing, and overseeing liability, property, automotive, general liability, and employment claims in accordance with state regulations. This position involves documenting activities, communicating information regarding claims and benefits, and providing testimony in disputes while exercising discretion, independent judgment, and critical thinking skills, all while delivering exceptional customer service.

Key Responsibilities

• Thoroughly evaluates and manages liability, property, automotive, general liability, and employment claims in compliance with state regulations.
• Adjudicates automotive and general liability claims for PRS Holdings Inc. and its associated entities, ensuring compliance with legal requirements and state statutes.
• Analyzes liability exposure for various branches to ensure appropriate actions are taken.
• Participates in legal hearings, settlement conferences, and mediations, providing testimony and monitoring proceedings.
• Assesses automotive and general liability claims to determine eligibility and appropriate course of action.
• Maintains comprehensive claims files and records to document actions and ensure compliance with policies and legal requirements.
• Oversees claims handling and third-party providers to ensure adherence to legal regulations.
• Prepares statistical summaries, evaluations, and reports, along with oral presentations to document activities and provide information.
• Responds to inquiries from claimants and involved personnel to resolve issues and facilitate communication.
• Delivers timely, balanced, and accurate claims reviews and documentation in a fast-paced environment, adhering to state and insurance department regulations.
• Acts as the representative of the company, providing proactive communication with claimants and customers, demonstrating empathy and active listening.
• Documents conversations within claim files promptly, utilizing professional writing skills.
• Interacts effectively with claimants, customers, healthcare providers, attorneys, brokers, and family members during the claims evaluation process.
• Compiles documentation and correspondence requiring detailed policy analysis.
• Analyzes information to determine if additional data is needed for reasonable claims determinations.
• Collaborates with external and internal resources to gather necessary data for informed claim decisions.
• Identifies and reconciles inconsistencies during information gathering and collaborates with underwriting and fraud prevention resources as needed.
• Calculates monthly benefits due after the elimination period, including offsets and non-routine payments.
• Addresses and resolves escalated customer complaints promptly and thoroughly.
• Performs additional duties as assigned.

Qualifications

• Demonstrated time management and follow-through skills, with the ability to manage multiple tasks under tight deadlines.
• Highly detail-oriented with excellent organizational capabilities.
• Prior experience demonstrating independent judgment, critical thinking, and decision-making skills.
• Exceptional written and oral communication skills, along with effective listening abilities.
• Motivated team player with a strong commitment to excellence and initiative.
• Proficient in risk management and handling complex situations effectively.
• Outstanding customer service skills, proven through interactions with internal and external customers.
• Strong analytical skills, particularly with numerical data.
• Familiarity with Microsoft Outlook, Word, and Excel.
• Adept at managing multiple systems and technology sources.

Education and Experience

• Bachelor's degree or a combination of education and relevant experience.
• 7+ years of experience in handling workers' compensation, liability, property, automotive, and general liability claims.
• Prior experience in damages and investigative work related to contractual disputes, claims, and litigation.
• Valid driver's license with an acceptable driving record.
• Understanding of multi-jurisdictional legal issues.

Why Join Us

• Participate in ESOP Retirement Benefits after one year of service, with typical annual contributions ranging from 10% to 15% of your salary.
• 401K Retirement Benefits available.
• Comprehensive health, dental, and vision insurance, along with supplemental health options.
• Paid Time Off (PTO) and holiday pay.
• Opportunities for career advancement and on-the-job training.
• Work with an industry leader across various disciplines and markets.

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this role. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions. While performing the duties of this job, the employee is regularly required to:

• Use hands to manipulate objects, tools, or controls and reach with hands and arms. Frequently required to stand, walk, and communicate.
• Regularly required to sit, climb, balance, stoop, kneel, crouch, or crawl.
• Occasionally lift and/or move up to 25 pounds. Specific vision abilities required include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

PRS Holdings Inc. is an equal opportunity employer, considering qualified applicants without regard to age, race, color, religion, creed, sex, sexual orientation, gender identity or expression, national origin, marital status, disability, or protected veteran status, or any other characteristic protected by law.