Claims Specialist (Contribution)

ICW Group•Pleasanton, CA

2d•$78,679 - $132,686•Hybrid

About The Position

The Claims Specialist position is responsible for handling complex claims with a focus on providing exceptional service for stakeholders in order to drive claims to an equitable resolution within Company standards. The Claims Specialist works with a sense of urgency, understands insurance coverage concepts, and navigates the legal system with the support of counsel to drive strategic outcomes. ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law.

Requirements

Bachelor's degree (or equivalent combination of education and experience) required along with a minimum of 8 – 10+ years’ related claims handling experience involving complex litigation, reserving, settlement strategy, and high exposure claims.
Certification that meets the minimum standards of training, experience, and skill required.
Excellent 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
Must have the ability to: Read, analyze, and interpret technical and legal documents
Write reports and business correspondence
Respond to common inquiries or complaints from customers (insured), claimants and regulatory agencies
Present information at meetings, to management and clients
Solve practical problems and deal with a variety of variables in situations where limited standardization exists
Excellent understanding of Workers’ Compensation and Personal Injury Laws and jurisdictional restraints to manage subrogation claims

Nice To Haves

WCCA and WCCP preferred.
State Workers Compensation License is required in some branches.
Paralegal certificate from an accredited program preferred.

Responsibilities

Manages complex claims inventories requiring advanced technical expertise and strategic claim handling
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 cross-functional Team Members for project and process discussions
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.
As a SME (subject matter expert), serves as a technical resource and mentors/trains less experienced Team Members
Investigates complex claims and gathers key information to assess potential subrogation/contribution actions.
Communicates with insureds to obtain information necessary for evaluating subrogation/contribution.
Pursues subrogation, recoveries and contributions within statutory timeframes.
Directs and manages legal counsel to ensure timely and cost-effective litigation.
Attends arbitrations and/or mediations virtually.
Analyzes police reports, investigative reports, policies, construction contracts, and OSHA reports.
Maintains case lists and follows up with claims personnel and outside attorneys.
Summarizes and analyzes depositions and medical reports/records.
Prepares department metric reports.
Resolves claims fairly and equitably, acting in the best interest of the insured.
Reports all recoveries to ensure they are credited to the claim file.
Coordinates the handling of contribution and subrogation recovery with the underlying case.
Maintains contribution/subrogation logs and records for referrals and recoveries.
Keeps an active diary and notepad documentation for all contribution/subrogation files.
Maintains diaries of important deadlines on cases.