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Senior Claims Specialist

3 months ago

The Woodlands, United States Sterling Infrastructure, Inc. Full time

Summary

Working within the claims team, responsible for analyzing and processing Workers’ Compensation, General Liability and Automobile Claims, characterized as moderately complex to complex within assigned authority limits. This includes assisting the insurance company adjuster on decisions about liability/compensability, evaluating losses, negotiating settlements, and managing an inventory of commercial property/casualty claims involving bodily injury or property loss.


Essential Duties and Responsibilities include, but are not limited to the following:

  • Assists in the day-to-day processing of Workers’ Compensation, Automobile Claims and General Liability claims, including obtaining, checking, recording, and evaluating employee and third-party information related to these claims.
  • Evaluates and processes claim handling invoices from insurers.
  • Addresses questions about Workers’ Compensation programs, and informs employees of their rights and benefits under various state workers’ compensation laws.
  • Acts as a liaison between the business unit and the worker’s compensation insurer on return-to-work programs.
  • Compiles and analyzes claims data and recommends lessons learned and claims process improvements.
  • Enters claims data in internal databases and runs claims reports from the databases.
  • Gathers information/data on accident causes, reports on hazardous or dangerous conditions/actions on company property/worksites, and coordinates with Safety and/or the Company’s insurance adjusters.
  • As it relates to Workers’ Compensation claims, assists in maintaining ongoing oversight of third-party providers that includes, but is not limited to, requesting investigation activities to verify suspicious claims, questioning and resolving discrepancies, monitoring of medical treatment, including rehabilitation, and reviewing case reserves for adequacy.
  • Works with the claims adjuster and/or defense counsel in identifying and interviewing witnesses. Works with the claims adjuster and/or defense counsel in the gathering and production of documents, and other information related to the claims.
  • Provides general assistance and works with internal and external counsel, and the insurance adjuster in the defense of a claim.
  • Works in a corporate office environment. Provides professional and prompt customer service to co-workers, insurance company personnel, and the general public.
  • May assist in restitution/subrogation activities when company property is damaged by 3rd parties.
  • Performs related duties as assigned.


Qualifications

This is an in-office cubicle position with office hours generally from 8 AM to 5 PM Central Time, Monday-Friday. 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 accommodations may be made to enable individuals with disabilities to perform essential functions.


General Knowledge of —


  • Various state labor code provisions pertaining to workers’ compensation rules, regulations, and appeals.
  • the ability to intake, report, and manage claims in worker’s comp and also auto and general liability.
  • Civil litigation and discovery procedures
  • Medical and legal terminology related to bodily injury claims


Ability to —


  • Analyze, interpret, and apply laws, rules, and regulations pertaining to workers’ compensation, occupational health and safety, automobile insurance, and general liability insurance.
  • Analyze individual claims and use judgment and diplomacy in recommending or exercising appropriate action.
  • Write clear, comprehensive, and accurate reports and correspondences.
  • Interpret statistics and make accurate arithmetical computations
  • Work effectively and professionally with corporate, business unit, insurance carrier adjusters, and the public
  • Effectively communicate orally and in writing.


Education —

Two years of college, preferably supplemented by courses in workers’ compensation, general business, insurance, or state-issued adjuster licenses. Worker’s compensation certifications are a plus


Experience —


Two to five years or more of experience as a workers' compensation claims processor/adjuster, which must include at least one year of experience regarding state workers’ compensation claims covered by any one or more of the following state laws: Arizona, Colorado, Florida, Georgia, Hawaii, Idaho, Nevada, Texas, or Utah.