Workers’ Compensation Senior Claims Examiner

PURPOSE OF THE JOB

The Senior Claims Examiner 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.

Essential Duties And 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.

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.
• Safeguards 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.
• Solves claims fairly and equitably, acting in the best interest of the insured while providing timely benefits to injured workers as required by law.

Long-Tailed Claims

• Provides technical guidance and collaborates with leadership on complex claim resolution strategies and specialty handling initiatives.
• 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.