Claims Specialist - Workers' Compensation (California)

About the role

The Claims Specialist position is responsible for handling complex claims with a focus on providing exceptional service for stakeholders in order to drive claims to an equitable resolution within Company standards. The Claims Specialist works with a sense of urgency, understands insurance coverage concepts, and navigates the legal system with the support of counsel to drive strategic outcomes.

Responsibilities

• Manages complex claims inventories requiring advanced technical expertise and strategic claim handling
• 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
• Directs defense counsel throughout the litigation process in line with ICW litigation guidelines while monitoring legal fees and costs
• All Claims Specialists consistently provides exceptional customer service
• Effectively collaborates with cross-functional Team Members for project and process discussions
• Makes recommendations for streamlining processes and adopting the industry’s best practices
• Serves as a technical resource and mentors/trains less experienced Team Members
• 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
• Supports specialty claim handling programs and strategic initiatives involving complex litigation, medical exposure, catastrophic injuries, fatality, PTD, or long-duration claims
• Provides technical guidance and collaborates with leadership on complex claim resolution strategies and specialty handling initiatives
• Identifies and drives resolution opportunities on complex or long-duration claims through proactive settlement, reserving, and medical management strategies
• Supervisory Responsibilities: This position has no supervisory responsibility

Requirements

• Bachelor's degree (or equivalent combination of education and experience) required along with a minimum of 8 – 10+ years’ related claims handling experience involving complex litigation, reserving, settlement strategy, and high exposure claims
• 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

Skills

• Excellent 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

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