Workers’ Compensation Senior Claims Examiner

ICW Group•San Diego, CA

16h•Hybrid

About The Position

The Senior Claims Examiner handles moderate to complex claims with a focus on providing the highest level of service for policyholders and ICW Group to independently bring claims to an equitable conclusion within Company standards and best practice guidelines. The Senior Claims Examiner works with a sense of urgency, understands insurance coverage concepts, and navigates the legal system with the support of counsel to drive strategic outcomes.

Requirements

Bachelor's degree (or equivalent education and experience) preferred.
Minimum 5+ years of related claims handling experience, including complex litigated claims (or combination of claims handling and other claims experience).
Workers’ Compensation: Certification that meets the minimum standards of training, experience, and skill required.
State Workers Compensation License is required in some branches.
Good understanding of laws and jurisdictional restraints to manage claim.
Excellent verbal communication skills, time management, attention to detail and organizational skills.
Must be adept at learning new technology.
Flexibility to adapt to changes in a fast-paced environment.
Must have the ability to: Read, analyze, and interpret technical and legal documents.
Write reports and business correspondence.
Respond to common inquiries or complaints from customers (insured), claimants and regulatory agencies.
Present information at meetings, to management and clients.
Solve practical problems and deal with a variety of variables in situations where limited standardization exists.
Workers’ Compensation: Advanced knowledge of workers’ compensation claims handling, reserving, litigation management, and resolution strategies.

Nice To Haves

WCCA and WCCP preferred.

Responsibilities

Manages all aspects of a moderate to highly complex claims inventory.
Effectively communicates with policyholders, agents, attorneys, and witnesses to gather information and provide the highest possible level of customer service.
Promptly investigates claims to determine exposure, works with appropriate experts and makes strategic recommendations.
Utilizes appropriate resolution tactics (e.g., mediation, negotiation, denial, litigation or offer) to proactively drive outstanding results.
Operates within the requirements of related state and/or the governing entity rules and regulations as well as internal claims handling policies and procedures.
Directs defense counsel throughout the litigation process in line with ICW litigation guidelines while monitoring legal fees and costs.
Consistently provides exceptional customer service.
Effectively collaborates with team members from various departments for project and process discussions.
Makes recommendations for streamlining processes and adopting the industry’s best practices.
Ensures accuracy of data in claims system for compliance with applicable regulatory reporting.
Provides knowledge transfer across the organization.
Continuously seeks to improve technical skills by attending job related training and tracking current case law.
Acts as a mentor and provides training for less experienced team members.
Serves as a technical resource and mentors less experienced Team Members.
Prepares and presents claims status reports for internal and external stakeholders.
Administers timely and appropriate benefits to injured workers; manages and approves payment of benefits within designated authority level.
Works within applicable state rules, regulations as well as ICW Group’s internal claims handling policies and procedures.
Creates and adjusts reserves in a timely manner to ensure reserving activities are consistent with company policies.
Resolves claims fairly and equitably, acting in the best interest of the insured while providing timely benefits to injured workers as required by law.
Provides technical guidance and collaborates with leadership on complex claim resolution strategies and specialty handling initiative.
Handles specialized claim inventories involving complex medical exposure, litigation, fatality, PTD, life pension, or long-term resolution strategies.
Identifies and drives resolution opportunities on complex or long-duration claims through proactive settlement, reserving, and medical management strategies.