Claims Examiner - Workers' Compensation (California)

ICW Group; California (MO); On-site; USD 62,000 - 98,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401K with company match

Bonus potential

Paid time off

Paid holidays

Job summary

ICW Group in San Diego, with nationwide offices, is seeking a Claims Examiner to handle a moderately complex workers’ compensation claims inventory with an emphasis on service and timely conclusions. You will investigate, negotiate, and coordinate with counsel to drive fair outcomes while complying with state rules and company policies.

The role requires a bachelor’s degree or equivalent and 1–4+ years of claims experience, plus strong communication and organizational skills.

Qualifications

• Bachelor's degree (or equivalent) and 1-4+ years of related claims handling experience.
• Good understanding of workers’ compensation laws and state rules.
• Strong communication, time management, and organizational skills.

Responsibilities

• Manages a moderately complex claims inventory with focus on service.
• Investigates claims to determine exposure and makes strategic recommendations.
• Utilizes resolution tactics to drive outcomes (mediation, negotiation, denial, litigation).
• Interacts with policyholders, agents, attorneys, and witnesses.
• Prepares claims status reports for stakeholders.
• Administers benefits within authority and ensures proper reserving.

Skills

Claims handling experience

Excellent communication

Attention to detail

Regulatory knowledge

Education

Bachelor's degree or equivalent

Tools

Workers’ Compensation systems

Job description

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 the twelfth consecutive year in a row and for the 20th time overall 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!

PURPOSE OF THE JOB

The Claims Examiner position handles a variety of claims with a focus on providing the highest level of service for policyholders and ICW Group to bring claims to an equitable conclusion within Company standards and best practice guidelines. The 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 moderately 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.

• Partners with defense counsel throughout the litigation process in line with ICW litigation guidelines while monitoring legal fees and costs

All Claims Examiners:

• Consistently provides exceptional customer service

• Effectively collaborates with cross-functional Team Members for project and process discussions

• Makes recommendations for streamlining processes

• 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

Workers’ Compensation Claims (Specific Responsibilities):

• 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

EDUCATION AND EXPERIENCE

Bachelor's degree (or equivalent combination of education and experience) required along with a minimum 1- 4+ years’ related claims or claims handling 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

• Basic to good understanding of laws and jurisdictional restraints to manage claims

• Excellent verbal communication skills, time management, attention to detail and organizational skills

• Must be adept at learning new technology

• Flexibility to adapt to changes in a fast-paced environment

Must have the ability to:

• Read, analyze, and interpret technical and legal documents

• Write reports and business correspondence

• Respond to common inquiries or complaints from customers (insured), claimants and regulatory agencies

• Present information at meetings, to management and clients

• Solve practical problems and deal with a variety of variables in situations where limited standardization exists

Workers’ Compensation:

Knowledge of workers’ compensation claims handling, reserving, litigation management, and resolution strategies

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.

This description is a general statement of essential job functions and responsibilities. The position may include other duties as assigned.

We are currently not offering employment sponsorship for this opportunity

The current range for this position is

$61,979.26 - $97,736.56

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

• 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: JR101635