Triage Claims Associate

ICW Group•Pleasanton, CA

2d•$23 - $36•Hybrid

About The Position

Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our journey as we strive to transform the insurance carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible. Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our internal and external communities better everyday! Learn more about why you want to be here! PURPOSE OF THE JOB The Triage Claims Associate for Workers’ Compensation plays a critical role in the initial assessment and routing of a claim. This position is responsible for reviewing incoming claims to determine the severity and urgency, as well as follow up actions needed by gathering all necessary information and initiating the 3-points of contact during the first 10 days in the life of assigned claims. This role ensures claims files are accurate and complete prior to their transfer to the indemnity claims team. A key objective of this role is to equip the Associate with the knowledge, skills, and abilities necessary to effectively manage a caseload of 70+ files and successfully complete either the SIP exam or earn the Claims Examiner designation within one year of hire for California. Additional Workers’ Compensation licensing may be required for other jurisdictions, as applicable.

Requirements

High school diploma or equivalent required.
Minimum 1+ year of related office or customer service experience.
Basic understanding of workers compensation terminology and claims processes (preferred).
Strong organizational and communication skills.
Adept at computer use including proficiency with on-line databases and/or claims management software (CXP or related) and Microsoft Office Suite.
Ability to work in a fast-paced, detail-oriented environment.
Strong analytical skills and demonstrated attention to detail.
Must have good time management skills and follow through on deliverables.
Collaborative with a team orientation and works with a sense of urgency for execution of deliverables.

Nice To Haves

Associate or Bachelor’s degree preferred.
Prior Workers’ Compensation industry experience highly preferred.

Responsibilities

Reviews and analyzes incoming workers' compensation claims to determine the severity of the claims, benefits owed, ensures medical treatment is communicated to the injured worker, and reviews the claims file for completeness and accuracy of details.
Communicates with injured workers, employers, medical providers, and internal teams to gather initial information.
Documents claim details and triage decisions in the claims management system.
Identifies potential fraud indicators and escalates as needed.
Maintains compliance with company policies and state regulatory requirements.
Supports continuous improvement initiatives within the triage process.

Benefits

Challenging work and the ability to make a difference
You will have a voice and feel a sense of belonging
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
Paid holidays throughout the calendar year
Want to continue learning? We’ll support you 100%

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