Triage Examiner

ICW Group•Pleasanton, CA

1d•Hybrid

About The Position

ICW Group is seeking team members who are driven to make an impactful difference and transform the insurance carrier space. With over 50 years in business and recognized as a Top 50 performing P&C organization, ICW Group offers stability and a people-focused environment. The company is headquartered in San Diego with regional offices across the U.S. The purpose of the Triage Examiner role is to administer benefits to injured workers in accordance with statutory and case law, as well as pertinent regulations. This position involves investigating, reserving, and assessing Workers’ Compensation claims within company standards and best practices, specifically managing Workers’ Compensation losses for the first 10 days of a claim's life.

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
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
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

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