Senior Claims Examiner - Workers' Compensation (California)
ICW Group · Pleasanton, CA · 4 wk ago
HybridFinance$68k–$115k/yrFull-time
We need to output HTML fragment with sections: About the role? The posting includes purpose of the job, essential duties, responsibilities, etc. We need headings: for section headings like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Use
for section headings like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Use - for any list of duties/requirements/benefits, and
for prose. Do NOT repeat job title as heading. Do NOT put Job ID/requisition numbers as headings; fold minor metadata into short
or drop it. Preserve all substantive info; do not invent or summarize away detail. Remove boilerplate, navigation, legal, EEO, equal-opportunity, scam-warning, duplicated lines, application instructions. Include a section ONLY when posting has real, specific content for it — never emit heading followed by filler/placeholder text (e.g., "commensurate with experience", "not specified", "N/A", "varies", "TBD") and never create Pay/Schedule/Benefits sections unless posting actually states them.
We have Pay: "The current range for this position is $68,481.25 - $115,489.01". So we can include Pay section.
Benefits: "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%". So we have Benefits content.
Schedule: Not explicitly mentioned; maybe full-time implied but not schedule details. The posting says "Job Type: Full time". That's schedule? Could be considered schedule but not explicit hours. The instruction: never create Pay/Schedule/Benefits sections unless posting actually states them. It states Job Type: Full time, which is schedule info. So we could include Schedule section with "Full time". However we need to see if that is considered schedule. Probably yes. But we need to avoid filler. "Full time" is specific. So include Schedule.
We also need About the role: Could be purpose of the job. Use heading About the role.
Responsibilities: Essential Duties And Responsibilities (including Workers' Compensation Claims specific responsibilities). We'll list as
- .
Requirements: Education And Experience, Certificates, Licenses, Registrations.
Qualifications: maybe Knowledge And Skills, Must Have The Ability To..., Physical Requirements, Work Environment. Could combine into Qualifications or Skills. But we need to avoid thin sections. Perhaps combine Knowledge And Skills, Must Have..., Physical Requirements, Work Environment into a Skills section? Or Qualifications. Let's decide: Use sections: About the role (purpose), Responsibilities, Requirements (education/experience, certifications), Qualifications (knowledge/skills, abilities, physical, work environment), Benefits, Pay, Schedule.
We must not repeat job title. No Job ID.
We must remove boilerplate: EEO statements, etc. Also remove "Learn more about why you want to be here!" maybe not needed but it's part of About the role? Could keep as prose but it's fluff. Might be considered boilerplate? It's promotional but not legal. Keep maybe.
We need to preserve all substantive information. So keep details about purpose, duties, responsibilities, etc.
Let's extract content:
Purpose of the job: "The Senior Claims Examiner position handles moderate to complex claims with a focus on providing the highest level of service for policyholders and ICW Group to independently bring claims to an equitable conclusion within Company standards and best practice guidelines. The Senior 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: list:
- Manages all aspects of a moderate to highly 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.
- Directs defense counsel throughout the litigation process in line with ICW litigation guidelines while monitoring legal fees and costs.
- All Claims Examiners Consistently provides exceptional customer service.
- Effectively collaborates with team members from various departments 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.
- Acts as a mentor and provides training for less experienced team members.
- Serves as a technical resource and mentors 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.
- Provides technical guidance and collaborates with leadership on complex claim resolution strategies and specialty handling initiative.
- Handles specialized claim inventories involving complex medical exposure, litigation, fatality, PTD, life pension, or long-term resolution strategies.
- 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.
Education And Experience: Bachelor's degree (or equivalent combination of education and experience) required along with a minimum of 5+ years’ related claims handling experience required; complex litigated claims experience is highly preferred.
CERTIFICATES, LICENSES, REGISTRATIONS:
- 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:
- 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
- Workers’ Compensation: Advanced 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. This description is a general statement of essential job functions and responsibilities. We are currently not offering employment sponsorship for this opportunity.
Pay: The current range for this position is $68,481.25 - $115,489.01 This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work.
Benefits: WHY JOIN ICW GROUP? Challenging work and the ability to make a differenceYou will have a voice and feel a sense of belongingWe offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company matchBonus potential for all positionsPaid Time OffPaid holidays throughout the calendar yearWant to continue learning? We’ll support you 100% ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ... (EEO boilerplate to remove). Also "At ICW Group we offer a work environment that encourages entrepreneurialism and celebrates success. Our team members are hands-on contributors who are given the opportunity to make an impact. It's our people who make us an employer of choice and the vibrant company we are today." That's fluff but maybe keep as part of Benefits? It's not specific benefit. Might be considered boilerplate but not legal. Could keep as prose but it's generic. Might be okay.
Schedule: Job Type: Full time.
We need to output only HTML fragment. Use
for each section heading. Use - for lists. Use
for prose.
We need to ensure we don't include empty sections.
Let's craft:
About the role
The Senior Claims Examiner position handles moderate to complex claims with a focus on providing the highest level of service for policyholders and ICW Group to independently bring claims to an equitable conclusion within Company standards and best practice guidelines. The Senior 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.
Responsibilities
- Manages all aspects of a moderate to highly 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.
- Directs 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 team members from various departments 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.
- Acts as a mentor and provides training for less experienced team members.
- Serves as a technical resource and mentors less experienced Team Members.
- 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.
- Provides technical guidance and collaborates with leadership on complex claim resolution strategies and specialty handling initiative.
- Handles specialized claim inventories involving complex medical exposure, litigation, fatality, PTD, life pension, or long-term resolution strategies.
- Identifies and drives resolution opportunities on complex or long-duration claims through proactive settlement, reserving
for prose. Do NOT repeat job title as heading. Do NOT put Job ID/requisition numbers as headings; fold minor metadata into short
or drop it. Preserve all substantive info; do not invent or summarize away detail. Remove boilerplate, navigation, legal, EEO, equal-opportunity, scam-warning, duplicated lines, application instructions. Include a section ONLY when posting has real, specific content for it — never emit heading followed by filler/placeholder text (e.g., "commensurate with experience", "not specified", "N/A", "varies", "TBD") and never create Pay/Schedule/Benefits sections unless posting actually states them. We have Pay: "The current range for this position is $68,481.25 - $115,489.01". So we can include Pay section. Benefits: "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%". So we have Benefits content. Schedule: Not explicitly mentioned; maybe full-time implied but not schedule details. The posting says "Job Type: Full time". That's schedule? Could be considered schedule but not explicit hours. The instruction: never create Pay/Schedule/Benefits sections unless posting actually states them. It states Job Type: Full time, which is schedule info. So we could include Schedule section with "Full time". However we need to see if that is considered schedule. Probably yes. But we need to avoid filler. "Full time" is specific. So include Schedule. We also need About the role: Could be purpose of the job. Use heading About the role. Responsibilities: Essential Duties And Responsibilities (including Workers' Compensation Claims specific responsibilities). We'll list as
- .
Requirements: Education And Experience, Certificates, Licenses, Registrations.
Qualifications: maybe Knowledge And Skills, Must Have The Ability To..., Physical Requirements, Work Environment. Could combine into Qualifications or Skills. But we need to avoid thin sections. Perhaps combine Knowledge And Skills, Must Have..., Physical Requirements, Work Environment into a Skills section? Or Qualifications. Let's decide: Use sections: About the role (purpose), Responsibilities, Requirements (education/experience, certifications), Qualifications (knowledge/skills, abilities, physical, work environment), Benefits, Pay, Schedule.
We must not repeat job title. No Job ID.
We must remove boilerplate: EEO statements, etc. Also remove "Learn more about why you want to be here!" maybe not needed but it's part of About the role? Could keep as prose but it's fluff. Might be considered boilerplate? It's promotional but not legal. Keep maybe.
We need to preserve all substantive information. So keep details about purpose, duties, responsibilities, etc.
Let's extract content:
Purpose of the job: "The Senior Claims Examiner position handles moderate to complex claims with a focus on providing the highest level of service for policyholders and ICW Group to independently bring claims to an equitable conclusion within Company standards and best practice guidelines. The Senior 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: list:
- Manages all aspects of a moderate to highly 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.
- Directs defense counsel throughout the litigation process in line with ICW litigation guidelines while monitoring legal fees and costs.
- All Claims Examiners Consistently provides exceptional customer service.
- Effectively collaborates with team members from various departments 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.
- Acts as a mentor and provides training for less experienced team members.
- Serves as a technical resource and mentors 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.
- Provides technical guidance and collaborates with leadership on complex claim resolution strategies and specialty handling initiative.
- Handles specialized claim inventories involving complex medical exposure, litigation, fatality, PTD, life pension, or long-term resolution strategies.
- 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.
Education And Experience: Bachelor's degree (or equivalent combination of education and experience) required along with a minimum of 5+ years’ related claims handling experience required; complex litigated claims experience is highly preferred.
CERTIFICATES, LICENSES, REGISTRATIONS:
- 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:
- 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
- Workers’ Compensation: Advanced 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. This description is a general statement of essential job functions and responsibilities. We are currently not offering employment sponsorship for this opportunity.
Pay: The current range for this position is $68,481.25 - $115,489.01 This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work.
Benefits: WHY JOIN ICW GROUP? Challenging work and the ability to make a differenceYou will have a voice and feel a sense of belongingWe offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company matchBonus potential for all positionsPaid Time OffPaid holidays throughout the calendar yearWant to continue learning? We’ll support you 100% ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ... (EEO boilerplate to remove). Also "At ICW Group we offer a work environment that encourages entrepreneurialism and celebrates success. Our team members are hands-on contributors who are given the opportunity to make an impact. It's our people who make us an employer of choice and the vibrant company we are today." That's fluff but maybe keep as part of Benefits? It's not specific benefit. Might be considered boilerplate but not legal. Could keep as prose but it's generic. Might be okay.
Schedule: Job Type: Full time.
We need to output only HTML fragment. Use
for each section heading. Use
- for lists. Use
for prose. We need to ensure we don't include empty sections. Let's craft:
About the role
The Senior Claims Examiner position handles moderate to complex claims with a focus on providing the highest level of service for policyholders and ICW Group to independently bring claims to an equitable conclusion within Company standards and best practice guidelines. The Senior 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.
Responsibilities
- Manages all aspects of a moderate to highly 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.
- Directs 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 team members from various departments 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.
- Acts as a mentor and provides training for less experienced team members.
- Serves as a technical resource and mentors less experienced Team Members.
- 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.
- Provides technical guidance and collaborates with leadership on complex claim resolution strategies and specialty handling initiative.
- Handles specialized claim inventories involving complex medical exposure, litigation, fatality, PTD, life pension, or long-term resolution strategies.
- Identifies and drives resolution opportunities on complex or long-duration claims through proactive settlement, reserving
- for lists. Use