Senior Claims Examiner
ICW Group
full-time
Posted on:
Location Type: Hybrid
Location: San Diego • California • 🇺🇸 United States
Visit company websiteSalary
💰 $68,481 - $115,489 per year
Job Level
Senior
About the role
- Manages all aspects of a complex California 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
- Acts as a Subject Matter Expert for the department
- 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
- 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.
Requirements
- Bachelor's degree from an accredited institution (or equivalent education and experience) along with 5+ years of related claims experience
- 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
- Good understanding of laws and jurisdictional restraints to manage claims
- Excellent verbal communication skills, time management, attention to detail and organizational skills required
- Ability to read, analyze, and interpret technical journals, financial reports, and legal documents
- Ability to write reports, business correspondence, and procedure manuals
- Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community
- Ability to effectively present information at meetings, to management and clients.
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 with an accrual rate of 5.23 hours per pay period (equal to 17 days per year)
- 11 paid holidays throughout the calendar year
- Want to continue learning? We’ll support you 100%
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims managementdata accuracyreserving activitieslitigation processnegotiationmediationreport writingregulatory compliancecustomer serviceclaims investigation
Soft skills
verbal communicationtime managementattention to detailorganizational skillscollaborationmentoringproblem-solvingpresentation skillsrecommendation makingknowledge transfer
Certifications
Bachelor's degreeState Workers Compensation LicenseWCCAWCCP