Triage Examiner

ICW Group•San Diego, CA

7d•Hybrid

About The Position

The Triage Examiner serves as the initial point of contact and manages claims during the early phase of the claim lifecycle (typically the first 10 days) in alignment with Company standards, best practices, and applicable laws and regulations. With a strong sense of urgency, the Triage Examiner drives early intervention to positively influence claim outcomes, optimize efficiency, and ensure a smooth transition to the next specialized claim examiner for ongoing management, while establishing a professional and positive tone that supports effective claim handling.

Requirements

High school diploma or general education degree (GED) required.
Minimum 2-3 years’ insurance claims such as auto, property, liability, workers’ compensation or related experience required.
At least 1+ year(s) of experience as a Triage Claims Associate or in a closely related workers’ compensation claim’s role.
California Only: All examiners must receive certification (Self Insurance (SIP) or Workers’ Compensation Claims Examiner designation) that meets the minimum standards of training, experience, skill, and further education as required.
All other jurisdictions: State Workers’ Compensation License as required.
Must obtain certifications within 1 year of hire into this role.
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.
Bilingual in Spanish preferred.

Responsibilities

Manages the early phase of the claims lifecycle by administering benefits to injured workers in accordance with statutory case law as well as pertinent regulations for the first 10 days of the claim.
Contacts and interviews injured workers, witnesses, medical providers, attorneys, agents, and policyholders to obtain information necessary for claim investigation and decision-making.
Communicates claim activity and processing with the injured worker and policyholder.
Makes initial compensability recommendations and evaluates benefit eligibility within assigned authority in accordance with applicable state laws and regulations, as well as ICW Group’s internal claims handling policies and procedures.
Creates reserves in a timely manner consistent with company standards and best practices guidelines.
Establishes accurate claim setup, including coding, documentation, and file notes, in alignment with Company standards.
Identifies risks, complexities, or escalation needs and refers matters to leadership as appropriate.
Develops initial action plans and sets claim diaries to support effective claim handling and transition.
Ensures a seamless and timely transition of claims to the next specialized claim examiner, including clear documentation, defined next steps, and appropriate claim direction.