Sr Liability Specialist (Hybrid)

*** Applications will be pulled for first review on Friday, September 6th, 2024 *** The Senior Liability Claims Specialist is responsible for managing a caseload of simple to complex cases within PRISM's General Liability programs. Caseload management requires monitoring and evaluating member claim files, reserves and coverage; collaborating with third party administrators (TPA) and self-administered members with regard to settlement or defense of their claim files; updating PRISM’s file records; presenting claims to the committees; and creating and maintaining open and constructive channels of verbal and written communication with all members, TPAs, defense counsel and reinsurers/excess carriers. JOB RESPONSIBILITIES Maintain diary to document updates, correspondence & strategies toward resolution on a 200+ pending claims caseload. Monitor and evaluate case strategy, litigation management, reserves and case statuses to ensure compliance with the PRISM Standards. Work with members and/or TPAs to ensure they are compliant with PRISM Standards in all aspects of claims handling. Make decisions regarding coverage for less complex exposures and generate coverage related correspondence. Properly code claim files in accordance with the PRISM coding standards. Engage coverage counsel on complex exposures as needed. Update reinsurers/excess carriers on cases involving their layer and/or cases they are monitoring. Present claims to the appropriate committees for settlement authority or coverage determination. Update information concerning claims and maintain claims files within the claims system, including documentation of analysis of the exposure and plan of action, file material in electronic environment, and appropriate claims fields in the system to maintain data integrity. Generate requisite reports from claims files. Contact member agencies, TPAs, defense counsel or reinsurers/excess carriers concerning claims status and information Create and maintain positive, collaborative relationships with members, committees, and staff. Actively participate in committee meetings as necessary. Attend mediations/MSCs as needed. There will be a moderate amount of travel (up to 25%) Support the PRISM Core Values and PRISM Mission. Assist with the overall success of the organizational strategic plan, goals, and objectives of the organization. Maintain strong customer service focus both internally and externally. Foster member relationships and assist members when needed. The ideal candidate will have a Bachelor’s Degree in directly related field or equivalent and five years increasingly responsible work in directly related field; or, an equivalent combination of education and experience sufficient to successfully perform the essential duties of the job, including but not limited to: Strong working knowledge in Microsoft Office including Word and Excel Experience working with a RMIS system (SIMS, iVOS, Valley Oaks, etc.) Ability to set priorities and handle multiple projects simultaneously Ability to handle basic arithmetical calculations Good presentation skills Ability to conduct research, analyze and interpret information Ability to establish and maintain effective working relationships and good public relations with other employees, agencies, members, and the public Knowledge of applicable laws and regulations Knowledge of research and evaluation techniques Completion of specialized educational training and courses related to insurance claims adjusting, reporting, settlement, and management are highly desirable Public agency claims experience is highly desirable Physical Requirements Physical requirements of this position typically include: reaching, grasping, talking, hearing, seeing, repetitive motions, exerting up to 20 pounds of force occasionally and/or up to 10 pounds of force frequently, and/or negligible amount of force constantly to move. Some travel may be required. Licensing Requirements A valid California Driver’s license is required. Proof of auto insurance with no exclusion for business use is required. A generous benefit package is provided including Public Employees Retirement System (PERS) health benefits, dental, vision, long-term disability, life insurance, PERS retirement, deferred compensation program, sick leave, vacation leave, and section 125 cafeteria benefits. PRISM employees do not pay into Social Security except for the Medicare portion of the cost.