Claims Examiner - Workers' Compensation (California)

ICW Group•Pleasanton, CA

2d•$61,979 - $97,737•Hybrid

About The Position

The Claims Examiner position handles a variety of claims with a focus on providing the highest level of service for policyholders and ICW Group to bring claims to an equitable conclusion within Company standards and best practice guidelines. The 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.

Requirements

Bachelor's degree (or equivalent combination of education and experience) required
Minimum 1- 4+ years’ related claims or claims handling experience.
Workers’ Compensation: Certification that meets the minimum standards of training, experience, and skill required.
State Workers Compensation License is required in some branches.
Basic to 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
Ability to read, analyze, and interpret technical and legal documents
Ability to write reports and business correspondence
Ability to respond to common inquiries or complaints from customers (insured), claimants and regulatory agencies
Ability to present information at meetings, to management and clients
Ability to solve practical problems and deal with a variety of variables in situations where limited standardization exists
Workers’ Compensation: Knowledge of workers’ compensation claims handling, reserving, litigation management, and resolution strategies

Nice To Haves

WCCA and WCCP preferred.

Responsibilities

Manages all aspects of a moderately 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.
Partners 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 cross-functional Team Members for project and process discussions
Makes recommendations for streamlining processes
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
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