Senior Claims Examiner - Workers' Compensation (California)

ICW Group; San Diego (CA); Remote; USD 68,000 - 115,000; Full time

Benefits offered by this job

401K retirement plans

Paid time off

Job summary

ICW Group in San Diego, CA seeks a Senior Claims Examiner to manage moderate to highly complex workers’ compensation claims with urgency and sound judgment. You will coordinate with policyholders, attorneys, and witnesses to drive equitable outcomes, while aligning with ICW Group guidelines.

The ideal candidate brings 5+ years of WC claims experience, a relevant license, and stellar communication, organization, and analytical skills.

Qualifications

• Bachelor's degree or equivalent plus 5+ years claims handling experience required; complex litigated claims experience preferred.
• Certification in Workers’ Compensation (WCCA and WCCP preferred). State license may be required in some branches.
• Strong communication, time management, attention to detail, and organizational skills.
• Ability to learn new technology and adapt to fast-paced environment.

Responsibilities

• Manages all aspects of a moderate to highly complex claims inventory.
• Communicates with policyholders, agents, attorneys, and witnesses to gather information and provide customer service.
• Investigates claims to determine exposure and makes strategic recommendations.
• Utilizes resolution tactics (mediation, negotiation, denial, litigation) to drive results.
• Directs defense counsel through litigation in line with ICW guidelines while monitoring costs.
• Provides training and mentorship to junior team members.
• Resolves complex claims with timely benefits and compliant reserving.

Skills

Legal knowledge

Communication skills

Learning new technology

Adaptability

Education

Bachelor's degree or equivalent

Job description

PURPOSE OF THE JOB

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

$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.

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: JR101672