Liability Claims Specialist OR Sr. Liability Claims Specialist

PRISM; Folsom (CA); On-site; USD 90,000 - 140,000; Full time

Job summary

PRISM is hiring for General Liability Specialist/Senior Specialist in California. The role manages a caseload of excess general liability claims, with oversight of TPAs and claims processes in excess programs.

Training occurs in Folsom for about a month, after which the employee may work full-time in Folsom, remotely from a home location within commuting distance, or hybrid. The position supports claims strategy, reserves, and settlements, requiring strong analytical and interpersonal skills and

Qualifications

• 2+ years of experience in claims adjusting, reporting or settlement work ( Specialist level ).
• Associate or Bachelor degree in relevant field; equivalent experience considered.
• Public Entity claims experience preferred.
• Coursework or certification in Liability Claims, Risk Management desirable.
• Strong interpersonal and customer service skills; professional interaction with members, TPAs and stakeholders.

Responsibilities

• Review new losses and provide timely responses to members and reinsurers.
• Maintain diary and update files with strategies toward resolution or trial on 150–200 pending claims.
• Evaluate liability and damages for less complex public entity excess files with supervisor oversight.
• Manage litigation in partnership with member entities and defense counsel.
• Monitor case strategy, reserves and status to ensure compliance with standards.
• Engage with members, TPAs and counsel to determine next steps toward settlement or trial.

Skills

Claims adjusting

Customer service

Interpersonal skills

Analytical thinking

Education

Bachelor's degree in Business Administration, Risk Management, Public Administration, or related field

Job description

This position may be filled at the Specialist or Sr. Specialist level, depending on the selected candidate's qualifications. The salary range is advertised broadly to reflect the two possible levels, and salary will be dependent on the selected candidate's qualifications.

For approximately the first month following hire, selected candidates will report to our Folsom office daily for training. After successful completion of training, selected candidates will have the option to work full time in our Folsom office, or remotely from a home location within a commutable distance from our Folsom, CA office, or a hybrid of both options. Candidates must be able and willing to report in person to our Folsom location when required which is generally 2 to 3 times per month, but could change based on business needs.

This recruitment is open until filled and application reviews will be conducted weekly until the positions are filled. PRISM is expanding the General Liability team and there are three positions to fill.

PRISM is a joint powers authority (JPA) that provides risk management and coverage programs for over 2,000 public entities throughout California. Our organization is member driven meaning that our members have numerous opportunities available to participate in the governance of our JPA.

The General Liability Specialist/Senior Specialist is responsible for managing a caseload of excess general liability claims, consisting of complex and catastrophic claims along with providing oversight of TPAs and claims processes in both our excess liability programs; reviewing and overseeing claims for appropriate claim strategy, reserves, reimbursement, reinsurance and resolution.

The responsibilities below will be performed at both the Specialist & Sr. Specialist level, but the complexity of the work will differ:

• Review all new losses assigned
• Provide timely response to members and reinsurers within established goals
• Effectively maintain current diary including file document updates, correspondence, and evaluation of strategies towards resolution or trial on a 150-200 pending claims caseload.
• Evaluate liability and damages for less complex public entity excess files with supervisors oversight
• Effectively manage litigation in partnership with member entities.
• Monitor and evaluate case strategy, litigation management, reserves and case status to ensure compliance with applicable Addendum B Standards as well as Defense Counsel Standards.
• Work with members, TPAs and defense counsel to evaluate case strategy, damages and future action needed with an eye towards settlement or trial.
• Analyze coverage for lesser complex exposures and generate coverage related correspondence with supervisor oversight.
• Engage coverage counsel for complex coverage issues as needed.
• Ensure losses have been reported to reinsurers/excess carriers and update reinsurers/excess carriers on cases involving their layer.
• Complete case analysis and closed session write ups as well as present claims to appropriate committee(s) for settlement authority, direction and/or coverage determination.
• Effectively maintain files in the PRISM proprietary claims system, including strict compliance with documentation standards relating to exposure analysis, action plans, data compliance, reserves, reinsurer acknowledgements and status and other correspondence.
• Generate requisite reports for diary and litigation calendar.
• Contact member agencies, TPAs, defense counsel or reinsurers/excess carriers concerning claims status and information.
• Review and approve reimbursements and reinsurer invoicing for assigned claims.
• Create and maintain positive, collaborative relationships with members, committees, staff, reinsurers and defense counsel.
• Actively participate in committee meetings as necessary.
• Attend medications/MSCs as needed.
• Communication regularly with Claims Supervisor and Liability Manager regarding claims activity and needed assistance.
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• Maintain familiarity with JPA governing documents and policies.
• Participate in personal professional development, including legal case law updates, educational seminars and conferences.
• Support PRISM Core Values and PRISM Mission.
• Assist with the overall success of the organizational strategic plan, goals and objectives of the organization.
• Lead with a strong customer service focus both internally and externally.
• Foster member relationships and assist members when needed, including assistance with claims, guidance regarding TPAs, and coordination of post-mortem claim reviews or quarterly claim reviews as requested.
• A moderate amount of travel is required.
• Perform other duties as assigned.

Qualifications at the Specialist Level

• Minimum 2 years experience of increasingly responsible work experience in claims adjusting, reporting, management and settlement work or an equivalent combination of education and experience sufficient to successfully perform the essential functions of the job.
• Associate's or Bachelor's degree in Business Administration, Risk Management, Public Administration or a related field. (An equivalent combination of education and relevant experience may be considered).
• Public Entity claims experience preferred.
• Coursework or certification in Liability Claims, Risk Management, or a related area is desirable.
• Strong interpersonal and customer service skills; ability to interact professionally with members, TPAs and other stakeholders.
• High level of integrity, professionalism, customer service, attention to detail, and critical thinking.
• Experience working with public agencies or joint powers authorities (JPAs) is a plus.

Qualifications at the Sr. Specialist Level

• Minimum 5 years of direct work experience in claims adjusting, reporting, management and settlement work of complex, litigated, catastrophic claims. Or five years of increasingly responsible work in a directly related field with at least three of those years working in pubic entity complex or excess casualty environment evaluating complex claims.
• Bachelor's degree in Business Administration, Risk Management, Public Administration, or a related field. (An equivalent combination of education and relevant experience may be considered).
• Public Entity claims experience preferred.
• Coursework or certification in Liability Claims, Risk Management or a related area is desirable.
• Strong analytical, interpersonal and customer service skills; ability to interact professionally with members, TPAs and other stakeholders.
• High degree of professionalism, customer service orientation, and ability to maintain cool in challenging and complex situations.
• High level of integrity, professionalism, customer service, attention to detail and critical thinking.
• Proven ability to mentor, train and guide junior-level staff or peers.
• Experience working with public agencies or joint power authorities (JPAs) is a plus.