Claims Examiner - Workers' Compensation (California)

About the role

The Claims Examiner position at ICW Group 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. This role requires a bachelor's degree and 1-4+ years of related claims or claims handling experience.

Responsibilities

• Manages all aspects of a moderately complex claims inventory
• 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
• All Claims Examiners consistently provide 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
• Solves claims fairly and equitably, acting in the best interest of the insured while providing timely benefits to injured workers as required by law

Requirements

• Bachelor's degree (or equivalent combination of education and experience)
• Minimum 1-4+ years’ related claims or claims handling experience
• 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

Qualifications

• Basic to good understanding of laws and jurisdictional restraints to manage claims
• Excellent verbal communication skills, time management, attention to detail and organizational skills
• Adept at learning new technology
• Flexibility to adapt to changes in a fast-paced environment
• The ability to read, analyze, and interpret technical and legal documents
• Write reports and business correspondence
• Present information at meetings, to management and clients
• Solve practical problems and deal with a variety of variables in situations where limited standardization exists

Skills

• Knowledge of workers’ compensation claims handling, reserving, litigation management, and resolution strategies