Claims Specialist - Workers' Compensation (California)

About the role

The Claims Specialist position at ICW Group is responsible for handling complex claims with a focus on providing exceptional service for stakeholders. This role involves managing complex claims inventories, communicating effectively with policyholders, agents, attorneys, and witnesses, and navigating the legal system with the support of counsel.

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 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 provide 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
• 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
• Serves as a subject matter expert (SME) 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
  • Solves 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
• 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

Qualifications

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

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

Benefits

ICW Group offers a competitive benefits package, including generous medical, dental, and vision plans, a 401K retirement plan, and company match. Bonus potential for all positions, paid time off, paid holidays throughout the calendar year, and opportunities for continued learning. Join a company committed to creating a diverse environment and celebrating success.