Claims Examiner - Workers' Compensation (California)

icwgroup; San Diego (CA); On-site; USD 60,000 - 95,000; Full time

Job summary

ICW Group seeks a Claims Examiner to manage a moderately complex claims inventory, communicating with policyholders, agents, attorneys, and witnesses to gather information. The role investigates claims, recommends strategic resolutions, and works within state rules and company policies to reach equitable outcomes.

The position emphasizes practical knowledge of workers' compensation, strong writing and speaking abilities, and collaboration with defense counsel throughout litigation processes.

Qualifications

• Bachelor's degree or equivalent with 1–4+ years of claims handling experience.
• Knowledge of workers' compensation laws and regulations.
• Excellent written and verbal communication skills.

Responsibilities

• Manage a moderately complex claims inventory and provide timely status updates.
• Communicate with policyholders, agents, attorneys, and witnesses to gather information.
• Investigate claims to determine exposure and make strategic recommendations.
• Utilize mediation, negotiation, denial, litigation, or offers to drive outcomes.
• Ensure compliance with state rules and internal policies.
• Collaborate with defense counsel and monitor legal costs.
• Provide knowledge transfer and ongoing training to team members.
• Maintain accurate data in the claims system for regulatory reporting.

Skills

Claims handling

Communication

Time management

Attention to detail

Education

Bachelor's degree

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! Learn more about why you want to be here.

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,