Triage Examiner

PURPOSE OF THE JOB

The purpose of this job is to administer benefits to injured workers in accordance with statutory and case law as well as pertinent regulations. This job investigates, reserves, and assesses Workers’ Compensation claims within the Company standards and best practices guidelines. This job exists to manage Workers’ Compensation losses for the first 10 days of the life of the claim.

Essential Duties And Responsibilities

• Administers benefits to injured workers in accordance with statutory case law as well as pertinent regulations for the first 10 days of the claim.
• Represents the Workers’ Compensation Department and ICW Group when interacting with injured workers.
• Communicates with insureds to obtain information necessary for processing claims.
• Contact and/or interviews injured workers, doctors, medical specialists, attorneys, and employers to get additional information.
• Communicates claim activity and processing with the injured worker and insured.
• Maintains professional client relationships.
• Communicates effectively with other Company departments.
• Creates reserves in a timely manner to ensure reserving activities are consistent with company standards and best practices guidelines.
• Manages and approves payment of benefits within designated authority level.
• Affords claims fairly and equitably, acting in the best interest of all parties and providing benefits as prescribed by law.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate to supervisor and management.
• Prepares an action plan and set diaries, in preparation for assigning the file to an examiner for permanent handling.

Supervisory Responsibilities

This role does not have supervisory responsibilities.

Education And Experience

• High school diploma or general education degree (GED) required.
• Bachelor’s degree from four-year college or university preferred.
• Minimum 1 year of insurance or claims related experience; or equivalent combination of education and experience required.

Certificates, Licenses, Registrations

• California Only: All examiners must receive certification that meets the minimum standards of training, experience, skill, and further education as required.
• California Only: California Workers’ Compensation Claims Administration (WCCA) and Workers’ Compensation Claim Professional (WCCP) certifications preferred.
• All other jurisdictions: State Workers’ Compensation License as required.