Triage Claims Associate

ICW Group; Pleasanton (CA); On-site; USD 47,000 - 74,000; Full time

Benefits offered by this job

Bonus potential

Paid time off

Paid holidays

401K with company match

Medical, dental, and vision

Job summary

ICW Group in Pleasanton, CA is seeking a Triage Claims Associate for Workers’ Compensation to assess and route claims early in life. You will review 70+ files and coordinate initial information, communications, and documentation to prepare for transfer to the indemnity team.

The role emphasizes timely triage, accuracy, and regulatory compliance, with potential SIP exam or designation pursuit within the first year in California.

Qualifications

• High school diploma or equivalent required; associate/bachelor degree preferred.
• Prior workers’ compensation/claims office experience is a plus.
• Strong organizational and communication skills are essential.

Responsibilities

• Review incoming workers’ compensation claims for severity and completeness.
• Gather initial information from injured workers, employers and providers.
• Document triage decisions in the claims system with accuracy.
• Identify potential fraud indicators and escalate as needed.
• Ensure compliance with policies and regulatory requirements.

Education

High school diploma

Associate degree

Bachelor's degree

Tools

CXP

Microsoft Office

Online databases

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 ten consecutive years 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 Triage Claims Associate for Workers’ Compensation plays a critical role in the initial assessment and routing of a claim. This position is responsible for reviewing incoming claims to determine the severity and urgency, as well as follow up actions needed by gathering all necessary information and initiating the 3-points of contact during the first 10 days in the life of assigned claims. This role ensures claims files are accurate and complete prior to their transfer to the indemnity claims team. A key objective of this role is to equip the Associate with the knowledge, skills, and abilities necessary to effectively manage a caseload of 70+ files and successfully complete either the SIP exam or earn the Claims Examiner designation within one year of hire for California. Additional Workers’ Compensation licensing may be required for other jurisdictions, as applicable.

Essential Duties And Responibilities

• Reviews and analyzes incoming workers' compensation claims to determine the severity of the claims, benefits owed, ensures medical treatment is communicated to the injured worker, and reviews the claims file for completeness and accuracy of details.
• Communicates with injured workers, employers, medical providers, and internal teams to gather initial information.
• Documents claim details and triage decisions in the claims management system.
• Identifies potential fraud indicators and escalates as needed.
• Maintains compliance with company policies and state regulatory requirements.
• Supports continuous improvement initiatives within the triage process.

Supervisory Responsibilities

This role does not have supervisory responsibilities

Education And Experience

• High school diploma or equivalent required. Associate or Bachelor’s degree preferred.
• Minimum 1+ year of related office or customer service experience.
• Prior Workers’ Compensation industry experience highly preferred.

Knowledge And Skills

• Basic understanding of workers compensation terminology and claims processes (preferred).
• Strong organizational and communication skills.
• Adept at computer use including proficiency with on-line databases and/or claims management software (CXP or related) and Microsoft Office Suite.
• Ability to work in a fast-paced, detail-oriented environment.
• Strong analytical skills and demonstrated attention to detail.Must have good time management skills and follow through on deliverables.
• Collaborative with a team orientation and works with a sense of urgency for execution of deliverables.

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 frequent use of a computer, telephone, copier, and other standard office equipment.

We are currently not offering employment sponsorship for this opportunity.

The current range for this position is

$22.54 - $35.54

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