ICW Group

Claims Specialist

• Manages all aspects of a 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.
• Works with 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.

Claims Examiner – Workers' Compensation

Auditor

• Conducts and leads audits of Company departments, programs, or processes designed to ensure that an adequate internal control structure exists, risks are properly identified and managed, and process efficiency is improved
• Prioritizes and schedules audits based on the audit plan and the needs of the Company
• Evaluates and appraises the functions and processes of each area or program with an emphasis on risk controls, internal controls, and process improvement
• Designs and executes appropriate objectives, scope, and work programs for audits based upon review of documented procedures and discussions with departmental management and supervisory executives
• Evaluates and appraises processes, policies, and procedures of each department or program to ensure they are comprehensive and appropriate
• Prepares written reports on the findings of each audit with recommendations for new or changed policies, procedures, internal controls, and/or process improvements
• Provides compliance support for Company departments in the areas of risk exposure, internal controls, and process improvements
• Ensures utilization of documented procedures within each department, assisting departments in development of written procedures as necessary
• Engages in mediation process with audited department as to implementation; refer irreconcilable recommendations to departmental management
• Follows up on approved recommendations within scheduled time frames
• Participates in process and internal control improvement initiatives
• Provides expertise, project management, and guidance both inside and outside the Internal Audit function
• Oversees the Company’s Model Audit Rule (MAR) testing process
• Consults with external auditors where appropriate
• Assists with discrete risk evaluation and internal control functions as assigned
• Identifies and assesses strategic risks
• Participates in the development of the annual audit plan and internal audit risk assessment
• Assists with the department’s analytics and automation efforts
• Maintains current professional practice knowledge and educate constituencies
• Participates in professional organizations relevant to the internal audit field
• Stays abreast of new regulations and standards affecting the company and the insurance industry
• Provides regular education about audit requirements, regulatory compliance, and process efficiency to customers and other constituencies as requested

Claims Examiner – Workers' Compensation

Senior Internal Auditor