Triage Claims Examiner

ICW Group • Pleasanton, CA • 1w ago

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 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.

ESSENTIAL DUTIES AND RESPONIBILITIES

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.

SUPERVISORY RESPONSIBILITIES

This role does not have supervisory responsibilities.

EDUCATION AND EXPERIENCE

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

Bilingual in Spanish highly preferred.

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.

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.

We are currently not offering employment sponsorship for this opportunity

LI-ET1 #LI-Hybrid

The current range for this position is

$53,890.79 - $84,981.63

This range is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work.

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)

11 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.

At ICW Group we offer a work environment that encourages entrepreneurialism and celebrates success. Our team members are hands-on contributors who are given the opportunity to make an impact. It's our people who make us an employer of choice and the vibrant company we are today.

Job Category: Claims

Job Type: Full time

Req ID: JR100805

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