Sterling Infrastructure, Inc. is looking for an experienced Claims Specialist to join their team.

Summary

Working within the claims team, responsible for analyzing and processing a high volume of Workers’ Compensation, General Liability, and Automobile Claims, characterized as moderately complex to complex within assigned authority limits. This includes making 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:

• Must have excellent customer service, relationship building, critical thinking and decision-making skills.
• Solid computer multitasking skills.
• Evaluate workers' compensation, general liability, and bodily injury claims to determine liability, extent of damage, and exposure.
• Manage third-party damage/injury claims to include negotiations and settlement.
• Reviews and evaluates all incident reports for completeness and clarity of data; analyzes data.
• Evaluate police reports, video footage, previous insurance claims, and other information to further understand the incident and assess liability.
• Prepare and report claims to insurance carriers. Provides documentation along with additional information requested to insurance adjusters and/or defense counsel.
• Communicates and interacts with medical professionals, project management, safety managers, claims adjusters, support agencies, and others to monitor and assess the progress of rehabilitation efforts, and to facilitate either return to work or, depending upon the medical status of the claimant, placement into appropriate alternative positions within the company, ensuring compliance with all appropriate regulations and guidelines.
• Prepares all necessary forms as required by various regulatory agencies.
• Actively participates in department claim reviews.
• Performs other related duties as assigned.

Qualifications

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.

General Knowledge of —

• Various state labor code provisions pertaining to workers’ compensation rules, regulations, and appeals.
• Standard claims evaluation techniques, references, and settlements.
• Medical and legal terminology related to workers’ compensation claims processing.

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 with corporate, Operating Unit, and insurance carrier personnel.
• Effectively communicate orally and in writing.

Preferred Experience —

Two to three years 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, California, Colorado, Hawaii, Idaho, Montana, Nevada, Texas, or Utah.

We are an equal opportunity employer: We do not discriminate based on race, color, national origin, religion, creed, sex, sexual orientation, gender identity, disability, age, genetic information, marital status, military status, membership or activity in a local human rights commission, or status with regard to public assistance, or any other characteristic protected by applicable law.