Senior Claims Processor- Remote

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. This recruitment is open until filled and application reviews will be conducted weekly until the positions are filled. PRISM is a joint powers authority (JPA) that provides risk management and coverage programs for over 2,000 public entities throughout California. 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.
Effectively maintain current diary including file document updates, correspondence, and evaluation of strategies towards resolution or trial on a 150-200 pending claims caseload.
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.
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.
Communication regularly with Claims Supervisor and Liability Manager regarding claims activity and needed assistance.
Maintain familiarity with JPA governing documents and policies.
Participate in personal professional development, including legal case law updates, educational seminars and conferences.
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.
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. (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; High level of integrity, professionalism, customer service, attention to detail, and critical thinking.
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. (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; 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.