Senior Workers' Compensation Claims Examiner (Lake Mary)

Are you looking for more than just a job? Do you want to have a voice and feel a sense of belonging? At ICW Group, we hire innovative people who consistently adapt, grow and deliver. We believe in hard work, a fun work environment, and embracing creativity that only comes about when talented people collaborate to develop solutions. Our mission is 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 seven consecutive years as a Top 50 performing P&C company offering the stability of a large, profitable and growing company combined with a small-company entrepreneurial spirit. Our purpose-driven ethos provides team members with opportunities to contribute, develop, and belong. 

PURPOSE OF THE JOB
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.

ESSENTIAL DUTIES AND RESPONSIBILITIES
Manages all aspects of a 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.

Additional Responsibilities:

• Consistently provides exceptional customer service.

• Effectively collaborates with team members from various departments for project and process discussions.

• Acts as a Subject Matter Expert for the department.

• 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.

Additional Responsibilities in Workers’ Compensation:

• 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.

Additional Responsibilities in Commercial Liability/Property:

• Handles claims in multiple jurisdictions and/or nationwide.

• Escalates claim summaries and makes strategic recommendations for approval.

• Frontloads investigations and moves with urgency by gathering information quickly to assess risk accurately.

• Examines claims investigated by outside adjusters.

• Works with vendors, independent adjusters and attorneys for claims assignments.

• Navigates the legal systems with counsel and builds rapport with opposing counsel.

• Attends depositions, hearings, and settlement conferences.

• Prioritizes early resolution options for every claim and attends resolution proceedings.

• Drafts coverage letters and correspondence with minimal to no guidance for management review.

• Researches and analyzes policy language, drafts correspondence with minimal to no guidance for management review.

• Provides advice to underwriters as necessary based on inspections, including any preexisting damages noted.

• Works to understand and learn the nuances of reinsuranc