Senior Claims Examiner

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.

• 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.

SUPERVISORY RESPONSIBILITIES
This position has no supervisory responsibility but will serve as a technical leader.

EDUCATION AND EXPERIENCE
Bachelor's degree from an accredited institution (or equivalent education and experience) along with 5+ years of related claims experience.

CERTIFICATES, LICENSES, REGISTRATIONS
Workers’ Compensation: Certification that meets the minimum standards of training, experience, and skill required. WCCA and WCCP preferred. State Workers Compensation License is required in some branches.
 

KNOWLEDGE AND SKILLS
Good understanding of laws and jurisdictional restraints to manage claims. Excellent verbal communication skills, time management, attention to detail and organizational skills required. Ability to read, analyze, and interpret technical journals, financial reports, and legal documents. Ability to write reports, business correspondence, and procedure manuals. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to effectively present information at meetings, to management and clients. Must be adept at learning new technology and embrace change.

PHYSIC