Senior Claims Examiner - Workers' Compensation (California)

ICW Group; Sacramento, Northern (CA, KY); Hybrid; USD 68,000 - 115,000; Full time

Job summary

ICW Group in Sacramento is seeking a Senior Claims Examiner to manage a portfolio of moderate to highly complex workers’ compensation claims.

You’ll collaborate with policyholders, attorneys, and witnesses, investigate promptly, and guide claims through settlement, mediation, or litigation while ensuring compliance and data accuracy.

Requires 5+ years of experience, a bachelor’s degree, and relevant certifications; hybrid office environment with potential advancement within ICW Group.

Qualifications

• 5+ years of related claims handling experience.
• Complex litigated claims experience preferred.
• WCCA and WCCP certifications preferred; state license required in some branches.

Responsibilities

• Manage moderate to highly complex workers' compensation claims.
• Communicate with policyholders, attorneys, and witnesses.
• Investigate claims promptly and determine exposure.
• Direct defense counsel during litigation per guidelines.
• Maintain accurate claims data for regulatory reporting.

Skills

Laws & regs

Verbal communication

Time management

Attention to detail

Organizational skills

Tech adaptability

Problem solving

Documentation

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! The Senior Claims Examiner position handles moderate to complex claims with a focus on providing the highest level of service for policyholders and ICW Group to independently bring claims to an equitable conclusion within Company standards and best practice guidelines. The Senior 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 moderate to highly 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.* Directs 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 team members from various departments 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.* Acts as a mentor and provides training for less experienced team members.* Serves as a technical resource and mentors 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.* Provides technical guidance and collaborates with leadership on complex claim resolution strategies and specialty handling initiative* Handles specialized claim inventories involving complex medical exposure, litigation, fatality, PTD, life pension, or long-term resolution strategies.* 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 5+ years’ related claims handling experience required; complex litigated claims experience is highly preferred. **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*** 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:** 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. **We are currently not offering employment sponsorship for this opportunity** #LI-ET1 #LI-Hybrid The current range for this position is$68,481.25 - $115,489.01 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.