Triage Examiner
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 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.
- California Only : All examiners must receive certification that meets the minimum standards of training, experience, skill, and further education as required.
- All other jurisdictions: State Workers’ Compensation License as required.
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.
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.
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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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
