Triage Examiner

icwgroup; San Diego (CA); Hybrid; USD 54,000 - 85,000; Full time

Job summary

ICW Group in San Diego seeks a Triage Examiner to serve as the initial contact and manage the early phase of the claim lifecycle. With a strong sense of urgency, you will influence outcomes and ensure a smooth transition to the next examiner.

You will interview injured workers, providers, and policyholders, determine eligibility, set reserves, document thoroughly, and escalate to leadership as needed, all while complying with state laws and company policies.

Qualifications

• High school diploma or GED required; bachelor's degree preferred.
• 2–3 years of insurance claims experience (auto, property, liability, workers' comp or related).
• At least 1 year as a Triage Claims Associate or related workers' comp role.
• Bilingual in Spanish preferred.

Responsibilities

• Manage early phase of claims lifecycle and apply benefits for the first 10 days.
• Interviews with injured workers, witnesses, medical providers, attorneys, agents, and policyholders to gather information.
• Communicate claim activity and processing to the insured and policyholder.
• Make initial compensability recommendations and evaluate benefit eligibility.
• Create reserves and establish accurate claim setup with proper documentation.
• Identify risks and escalation needs, referring matters to leadership as appropriate.
• Develop action plans and claim diaries to support transitions to the next examiner.

Skills

Communication skills

Time management

Attention to detail

Teamwork

Urgency

Conflict resolution

Problem solving

Decision making

Education

High school diploma or GED

Bachelor's degree preferred

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 Triage Examiner serves as the initial point of contact and manages claims during the early phase of the claim lifecycle (typically the first 10 days) in alignment with Company standards, best practices, and applicable laws and regulations. With a strong sense of urgency, the Triage Examiner drives early intervention to positively influence claim outcomes, optimize efficiency, and ensure a smooth transition to the next specialized claim examiner for ongoing management, while establishing a professional and positive tone that supports effective claim handling.

ESSENTIAL DUTIES AND RESPONIBILITIES

• Manages the early phase of the claims lifecycle by administering benefits to injured workers in accordance with statutory case law as well as pertinent regulations for the first 10 days of the claim.
• Contacts and interviews injured workers, witnesses, medical providers, attorneys, agents, and policyholders to obtain information necessary for claim investigation and decision-making.
• Communicates claim activity and processing with the injured worker and policyholder.
• Makes initial compensability recommendations and evaluates benefit eligibility within assigned authority in accordance with applicable state laws and regulations, as well as ICW Group's internal claims handling policies and procedures.
• Creates reserves in a timely manner consistent with company standards and best practices guidelines.
• Establishes accurate claim setup, including coding, documentation, and file notes, in alignment with Company standards.
• Identifies risks, complexities, or escalation needs and refers matters to leadership as appropriate.
• Develops initial action plans and sets claim diaries to support effective claim handling and transition.
• Ensures a seamless and timely transition of claims to the next specialized claim examiner, including clear documentation, defined next steps, and appropriate claim direction.

SUPERVISORY RESPONSIBILITIES

This role does not have supervisory responsibilities.

EDUCATION AND EXPERIENCE

• High school diploma or general education degree (GED) required. Bachelor's degree from four-year college or university preferred.
• Minimum 2-3 years' insurance claims such as auto, property, liability, workers' compensation or related experience required.
• At least 1+ year(s) of experience as a Triage Claims Associate or in a closely related workers' compensation claim's role.
• Bilingual in Spanish preferred.

CERTIFICATES, LICENSES, REGISTRATIONS

• California Only: All examiners must receive certification (Self Insurance (SIP) or Workers' Compensation Claims Examiner designation) that meets the minimum standards of training, experience, skill, and further education as required.
• All other jurisdictions: State Workers' Compensation License as required.
• Must obtain certifications within 1 year of hire into this role.

KNOWLEDGE AND SKILLS

• Basic understanding of laws and jurisdictional restraints to manage injuries.
• Excellent verbal and written communication skills, time management and organizational skills.
• Requires a high level of attention to detail.
• Team oriented and a sense of urgency for execution.
• Able to resolve conflicts fairly and equitably.
• Problem solving and decision-making ability.

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.

We are currently not offering employment sponsorship for this opportunity

#LI-ET1 #LI-hybrid

Salary Information

The current range for this position is $53,890.79 - $84,981.63

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 c