Claims Specialist - Workers' Compensation (California)

ICW INSURANCE COMPANY OF THE WEST; Carmel Point (CA); Hybrid; USD 79,000 - 133,000; Full time

Benefits offered by this job

Hybrid work environment

Competitive benefits

401(k) retirement plan with company -

Job summary

ICW Group is seeking a Claims Specialist to handle complex workers’ compensation claims with a focus on equitable resolutions. You will assess exposure, coordinate with counsel, and guide stakeholders toward timely, fair outcomes.

The role emphasizes strong communication, regulatory compliance, and mentoring teammates as a subject matter expert. A bachelor's degree and 8–10+ years of experience are required.

Qualifications

• Bachelor's degree in a related field and 8-10+ years of complex claims handling.
• Strong understanding of workers' compensation laws and state rules.
• Ability to negotiate and resolve complex claims with stakeholders.

Responsibilities

• Manage complex claims inventories with strategic handling.
• Communicate with policyholders, agents, attorneys, and witnesses to gather information.
• Investigate claims promptly to determine exposure.
• Direct defense counsel through litigation in line with policies.
• Prepare claims status reports for internal and external stakeholders.

Skills

Legal/claims knowledge

Communication skills

Attention to detail

Adaptability

Learning new tech

Education

Bachelor's degree or equivalent

8-10+ years claims handling experience

Tools

Claims system

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 Specialist position is responsible for handling complex claims with a focus on providing exceptional service for stakeholders in order to drive claims to an equitable resolution within Company standards. The Claims Specialist 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 complex claims inventories requiring advanced technical expertise and strategic claim handling
• 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
• Directs defense counsel throughout the litigation process in line with ICW litigation guidelines while monitoring legal fees and costs

All Claims Specialists:

• Consistently provides exceptional customer service
• Effectively collaborates with cross-functional Team Members for project and process discussions
• Makes recommendations for streamlining processes and adopting the industry’s best practices
• 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

As a SME (subject matter expert), serves as a technical resource and mentors/trains less experienced Team Members.

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.
• Supports specialty claim handling programs and strategic initiatives involving complex litigation, medical exposure, catastrophic injuries, fatality, PTD, or long-duration claims
• Provides technical guidance and collaborates with leadership on complex claim resolution strategies and specialty handling initiative
• Identifies and drives resolution opportunities on complex or long-duration claims through proactive settlement, reserving, and medical management strategies.

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 of 8 - 10+ years' related claims handling experience involving complex litigation, reserving, settlement strategy, and high exposure claims.

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

• Excellent 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: Advanced 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 #LI-ET1 #LI-Hybrid

The current range for this position is $78,678.61 - $132,686.15 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.

____________________ Job Category Claims 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.