[Hiring] Claims Examiner @ICW Group

Role Description

Seeking Workers' Compensation Claims Examiners. Training will be provided for handling California jurisdiction.

The Claims Examiner position handles a variety of claims with a focus on providing the highest level of service for policyholders and ICW Group to bring claims to an equitable conclusion within Company standards and best practice guidelines. The Claims Examiner works with a sense of urgency, understands insurance coverage concepts, and navigates the legal system with the support of counsel to drive strategic outcomes.

Essential Duties and Responsibilities

• Manages all aspects of a moderately complex claims inventory.
• Effectively communicates with policyholders, agents, attorneys, and witnesses to gather information and provide the highest possible level of customer service.
• Promptly investigates claims to determine exposure, works with appropriate experts and makes strategic recommendations.
• Utilizes appropriate resolution tactics (e.g., mediation, negotiation, denial, litigation or offer) to proactively drive outstanding results.
• Operates within the requirements of related state and/or the governing entity rules and regulations as well as internal claims handling policies and procedures.
• Partners with defense counsel throughout the litigation process in line with ICW litigation guidelines while monitoring legal fees and costs.

• Consistently provides exceptional customer service.
• Effectively collaborates with cross-functional Team Members for project and process discussions.
• Makes recommendations for streamlining processes.
• Ensures accuracy of data in claims system for compliance with applicable regulatory reporting.
• Provides knowledge transfer across the organization.
• Continuously seeks to improve technical skills by attending job related training and tracking current case law.

Workers’ Compensation Claims (Specific Responsibilities)

• Prepares and presents claims status reports for internal and external stakeholders.
• Administers timely and appropriate benefits to injured workers; manages and approves payment of benefits within designated authority level. Works within applicable state rules, regulations as well as ICW Group’s internal claims handling policies and procedures.
• Creates and adjusts reserves in a timely manner to ensure reserving activities are consistent with company policies.
• Resolves claims fairly and equitably, acting in the best interest of the insured while providing timely benefits to injured workers as required by law.

Qualifications

• Bachelor's degree (or equivalent combination of education and experience) required along with a minimum 1-4+ years’ related claims or claims handling experience.

Requirements

• Workers’ Compensation Certification that meets the minimum standards of training, experience, and skill required. WCCA and WCCP preferred. State Workers Compensation License is required in some branches.

Knowledge and Skills

• Basic to good understanding of laws and jurisdictional restraints to manage claims.
• Excellent verbal communication skills, time management, attention to detail and organizational skills.
• Must be adept at learning new technology.
• Flexibility to adapt to changes in a fast-paced environment.
• Must have the ability to:
• Read, analyze, and interpret technical and legal documents.
• Write reports and business correspondence.
• Respond to common inquiries or complaints from customers (insured), claimants and regulatory agencies.
• Present information at meetings, to management and clients.
• Solve practical problems and deal with a variety of variables in situations where limited standardization exists.
• Knowledge of workers’ compensation claims handling, reserving, litigation management, and resolution strategies.

Physical Requirements

• Office environment – no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear.

Work Environment

• This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment.

Benefits

• Challenging work and the ability to make a difference.
• You will have a voice and feel a sense of belonging.
• We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match.
• Bonus potential for all positions.
• Paid Time Off.
• Paid holidays throughout the calendar year.
• Want to continue learning? We’ll support you 100%.