Triage Examiner

ICW Group•San Diego, CA

2d•Hybrid

About The Position

The purpose of this job is to administer benefits to injured workers in accordance with statutory and case law as well as pertinent regulations. This job investigates, reserves, and assesses Workers’ Compensation claims within the Company standards and best practices guidelines. This job exists to manage Workers’ Compensation losses for the first 10 days of the life of the claim.

Requirements

High school diploma or general education degree (GED) required.
Minimum 1 year of insurance or claims related experience; or equivalent combination of education and experience required.
Basic understanding of laws and jurisdictional restraints to manage injuries.
Excellent verbal and written communication skills, time management and organizational skills.
Requires a high level of attention to detail.
Team oriented and a sense of urgency for execution.
Able to resolve conflicts fairly and equitably.
Problem solving and decision-making ability.

Nice To Haves

Bachelor’s degree from four-year college or university preferred.
California Only: California Workers’ Compensation Claims Administration (WCCA) and Workers’ Compensation Claim Professional (WCCP) certifications preferred.
All other jurisdictions: State Workers’ Compensation License as required.

Responsibilities

Administers benefits to injured workers in accordance with statutory case law as well as pertinent regulations for the first 10 days of the claim.
Represents the Workers’ Compensation Department and ICW Group when interacting with injured workers.
Communicates with insureds to obtain information necessary for processing claims.
Contacts and/or interviews injured workers, doctors, medical specialists, attorneys, and employers to get additional information.
Communicates claim activity and processing with the injured worker and insured.
Maintains professional client relationships.
Communicates effectively with other Company departments.
Creates reserves in a timely manner to ensure reserving activities are consistent with company standards and best practices guidelines.
Manages and approves payment of benefits within designated authority level.
Assesses claims fairly and equitably, acting in the best interest of all parties and providing benefits as prescribed by law.
Ensures claim files are properly documented and claims coding is correct.
Refers cases as appropriate to supervisor and management.
Prepares an action plan and set diaries, in preparation for assigning the file to an examiner for permanent handling.