Claims Examiner

Claims Examiner

Requirements

• Bachelor’s degree from an accredited institution (or equivalent education and experience) along with 1+ years of related claims experience or completion of ICW Claims Academy
• State Workers Compensation License is required in some branches
• Basic understanding of laws and jurisdictional restraints to manage claims
• Good verbal communication skills, time management, attention to detail and organizational skills required
• Ability to read, analyze, and interpret technical journals, financial reports, and legal documents
• Ability to write reports, business correspondence, and procedure manuals
• Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community
• Ability to effectively present information in meetings and to management
• Must be adept at learning new technology and embrace change

Responsibilities

• Manages all aspects of a complex claims inventory for California jurisdiction
• 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
• Works with defense counsel throughout the litigation process in line with ICW litigation guidelines while monitoring legal fees and costs
• Consistently provides exceptional customer service
• Effectively collaborates with team members from various departments for project and process discussions
• Acts as a Subject Matter Expert for the department
• 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
• 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
• 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

Preferred Qualifications

• WCCA and WCCP preferred