Essential Duties and Responsibilities: Include the following. Other duties may be assigned.
Implement and update PVTA’s Claims policies and procedures: Maintain and develop professional knowledge of all regulatory requirements and internal procedures; evaluate all department processes/procedures on an ongoing basis and develop/revise policies and procedures related to all operational aspects of claims management and processing.
Manage Department Operations: Manage day-to-day activities within the claims department, including claims adjustment and processing, accident investigations, database management, and litigation; Responsible for all administrative tasks involved with Claims Management including but not limited to , new cases, file management (electronic and hard copy) of new and old cases, statutes and regulations, the legal process, internal policies and procedures, related laws; and serve as resource for all claims-related matters.
Oversee Accident Investigation Process: Responsible formonitoring of all claims issues; conduct in-depth investigation processes by collecting all relevant information including coordination of investigation process with relevant parties to ensure proper claims handling; review incident/accident reports and ensure proper investigations are conducted according to established procedures; conduct interviews with operators, claimants, witnesses, attorneys and other relevant parties; coordinate claims processing and arrange for appraisals and independent medical examination when appropriate; request and review related medical records as required.
Maintain oversight of settlement procedures: Execute efficient claims resolution and liability containment strategies; set up and properly adjust case reserves; contact insurance companies to engage in settlement activities including negotiations and third-party liability (subrogation); identify key claim issues and work to bring these issues to resolution; authorize claims payments, settlement checks, and payment of other related expenses within granted authority.
Actively participate in litigation procedures: Coordinate efforts with outside legal counsel when appropriate; attend all depositions, mediation conferences and court trials related to claims litigation; discuss cases, coverage and policy decisions with outside legal counsel as appropriate and assist with preparing cases for suit; conduct analysis of litigation management and provide feedback to outside counsel on performance issues impacting claims results.
Oversee Claims Database Management and provide related reporting: Manage all exposures including coverage analysis, liability and injury/damage evaluations and subrogation/deductible recovery; oversee transportation suppliers and ensure compliance with PVTA’s policies and procedures related to claims; track and analyze monthly loss run data; prepare Loss Run Reports for high exposure claims and internal/external reporting of same; manage and maintain all oversight files.
Keep Management Informed: Keep Director of Transit Operations fully informed on Claims activities via monthly update meetings that will include but not limited to discussion of status on large claims and summary reports of Claims inventory and reserves. Assist with the development and tactical/strategic plans and inform management of progress towards related goal attainment; maintain current claims information; compile, create, and distribute reports including but not limited to:
· Incident/accident reports identifying all pertinent information (contractor accident information, dates, location, etc.).
· Interview reports identifying accident victims, witnesses, drivers, and any other related parties.
· Appraisal reports, which clearly identify the accident, insurance company, adjuster, accident site, etc.
· Independent Medical Exam (IME Reports), corresponding to related accidents.
· Documentation pertaining to meetings with claimants and attorneys.
· Documentation identifying settlement options that were recommended, to whom, and result.
· Log of contact information pertaining to discussions with insurance companies, including settlements, negotiations and subrogation details.
· Log of specific cases and the legal processes utilized.
· Loss and expense reports.
· Reports of all depositions, mediation conferences and court trials attended, along with the result.
· Reports of all monies owed, monies collected, and related documentation.
· Reports identifying releases, settlement amounts, expenses related to claims, and proposed vs. resulting settlements; and
· Reports identifying specific claims and status.
Perform all other related duties as requested.
Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience: Bachelor's degree (B.S.) from a four-year college or university; with a minimum of at least 7 years of directly related experience and/or training; demonstrated progressive claims experience with increasing responsibility with claims handling practices and procedures; or equivalent combination of education and experience; experience with claims litigation management and working knowledge of insurance law; demonstrated cost containment skills; ability to analyze claims and make recommendations on their disposition; excellent technical, communication, negotiation, analytical, and mathematical skills; excellent command of the English language, both written and verbal; ability to gather, analyze, interpret, summarize and present statistical data; strong business and/or report writing skills; strong organizational and time-management skills; ability to prioritize workload and meet tight deadlines; excellent problem-solving and decision-making skills with the ability to identify and implement creative solutions; ability to interact effectively and professionally with multiple constituencies, both internal and external, with a high level of customer service skills; must be able to work efficiently both independently and as part of a team; strong work ethic; must be able to handle difficult situations with professionalism, diplomacy and tact; ability to maintain confidentiality of information. Must be able to work on-site on a full-time basis as this is not a remote or hybrid position.
Computer Skills: Proficient with database, claims & legal business software systems; Microsoft Office; spreadsheets; and statistical software; experience with developing and maintaining estimating software programs
Preferred Qualifications: Experience with claims within public transit; AIC, SCLA, or CPCU designation (or completion of any related coursework).
Reports to: Director of Transit Operations
Supervisory Responsibilities: No direct supervisory responsibilities.
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, stand, and walk; use hands, talk, and hear. Regular viewing of the computer screen and use of the computer keyboard are required. Specific vision abilities include close vision and the ability to focus. Some travel is required.
Work Environment: The work environment described here is representative of that to which an employee is exposed while performing the essential functions of this job. The work environment is a typical office environment. The noise level in this environment is usually quiet. The employee may be exposed to weather conditions when engaging in job-related, local travel.
