Triage "Initial Investigation" Claims Examiner - job 2 of 2

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.

The Triage Claims Examiner will administer benefits to injured workers in accordance with statutory and case law as well as pertinent regulations. This job investigates, reserves, and assesses Workers’ Compensation claims within the Company standards and best practices guidelines. This job exists to manage Workers’ Compensation losses for the first 10 days of the life of the claim.

WHAT YOU WILL DO

Administers benefits to injured workers in accordance with statutory 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 and approves payment of benefits within 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.

WHAT YOU BRING TO THE ROLE

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

• 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.

COMPENSATION

The salary range listed for this position, $51,324.56 to $80,934.88, is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors such as skills, experience and/or education. In addition, we believe in the importance of pay equity and consider internal equity of our current team members as part of any final offer. We typically do not hire at the maximum of the range in order to allow for future and continued salary growth. We also offer a substantial benefits package outlined below.

WHY JOIN ICW GROUP?

• Challenging work and the ability to make a difference
• You will have a voice and feel a sense of belonging
• We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match
• Bonus potential for all positions
• Paid Time Off with an accrual rate of 5.23 hours per pay period (equal to 17 days per year)
• 10 paid holidays throughout the calendar year
• Want to continue learning? We’ll support you 100%

ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law.

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