Senior Triage Examiner

Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our  journey as we strive to transform the insurance  carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission 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 ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our  internal and external communities better everyday! Learn more about why you want to be here!

PURPOSE OF THE JOB

The purpose of this job is to manage new Workers’ Compensation losses for the first 10 days of the life of the claim.  This job takes necessary steps to assess and summarize new losses, prepare an action plan, set diaries, and reserve the file, all in preparation for assigning the file to an examiner for permanent handling.   

ESSENTIAL DUTIES AND RESPONIBILITIES

Administers benefits to injured workers in accordance with statutory and 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 complex claims and approves payment of benefits within higher 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.   
• Assists with special projects and development of more junior team members as needed.

SUPERVISORY RESPONSIBILITIES 

This role does not have supervisory responsibilities but may mentor and/or train junior team members.

EDUCATION AND EXPERIENCE

High school diploma or general education degree (GED) required.  Bachelor’s degree from four-year college or university preferred. Minimum of 2-3 years of insurance or claims related experience, or equivalent combination of education and experience required.  Minimum 1-2 years of workers’ compensation claims experience required.

CERTIFICATES, LICENSES, REGISTRATIONS

California Only: All examiners must receive certification that meets the minimum standards of training, experience, skill, and further education as required.  

California Only: California Workers’ Compensation Claims Administration (WCCA) and Workers’ Compensation Claim Professional (WCCP) certifications preferred.  

All other jurisdictions: State Workers’ Compensation License as required.

KNOWLEDGE AND SKILLS

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, 

PHYSICAL REQUIREMENTS  

Office environment – no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear.  

WORK ENVIRONMENT  

This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment