Claims Specialist - Workers' Compensation (California)

icwgroup; San Diego (CA); On-site; USD 90,000 - 130,000; Full time

Job summary

ICW Group in San Diego, CA is seeking a seasoned Workers' Compensation Claims Specialist to manage complex claims with a focus on fair, timely resolutions under company standards.

The role requires 8–10+ years in claims handling, strong knowledge of state workers' compensation rules, and certification such as WCCA/WCCP; state license may be required in some branches.

You will collaborate with policyholders, attorneys, and teams to drive outcomes, mentor others, and uphold regulatory compliance.

Qualifications

• Bachelor's degree (or equivalent) required with 8–10+ years' related claims handling experience involving complex litigation, reserving, settlement strategy, and high exposure claims.
• Excellent understanding of workers' compensation laws and jurisdictional rules.
• WCCA and WCCP certifications preferred; state license required in some branches.

Responsibilities

• Handle complex workers' compensation claims with focus on equitable resolutions within company standards.
• Communicate with policyholders, attorneys, and witnesses to gather information and provide service.
• Investigate claims to determine exposure and make strategic recommendations.
• Direct defense counsel and monitor costs through litigation processes.
• Mentor less experienced team members and share knowledge across the organization.

Skills

Complex claims handling

Stakeholder communication

Regulatory knowledge

Attention to detail

Education

Bachelor's degree

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-pac