ICW Group · 10 hours ago
Major Claims Examiner
Sacramento, CA
Full-time
Onsite
Senior Level, Lead/Staff
$91K/yr - $153K/yr
10+ years expICW Group is a well-established insurance company with over 50 years in the industry, focused on transforming the insurance carrier space. They are seeking a Major Claims Examiner to manage complex workers’ compensation claims, ensuring timely and fair resolutions while supporting injured workers' recovery.
Financial ServicesInsurance
No H1B
Responsibilities
Investigates and gathers necessary information to resolve assigned claims
Examines major and catastrophic claims to determine coverage, liability, and damages
Communicates with insureds to obtain information necessary for processing claims
Partners with legal counsel on litigation strategies while maintaining file ownership
Attends depositions and conferences exercising appropriate prioritization based on workload
Contacts and/or interview claimants, doctors, medical specialists, or employers to obtain relevant information
Conducts thorough investigations, including reviewing medical records, legal documents, and other supporting evidence. Directs additional investigation of questionable claims to determine compensability
Identifies potential fraud indicators and escalate as necessary
Manages and approves benefit payments within authority limits, ensuring compliance with state regulations and internal standards
Effectively communicates exposure and strategies to senior leadership
Resolves claims fairly and equitably, acting in the best interest of the insured and providing benefits as prescribed by law and in accordance with company standards
Utilizes structured settlements to resolve high exposure claims
Serves as a mentor and works closely with branch staff to devise strategy for reserving and settlement on high exposure claims, as requested
Identifies opportunities to engage with other company departments including managed care, legal, payment recovery, and SIU
Attends settlement mediations and conferences, as necessary
Participates in claim reviews and service calls with insureds and prospective insureds
Researches historical billing data for facilities and providers to establish accurate file reserves
Analyzes and reports catastrophic and major claims loss data to WCC leaders
Implements proactive and strategic plans to bring claims to a timely and appropriate resolution
Anticipates future developments and exposures and maintain accurate reserves
Pursues subrogation in most cases; refers and/or follows up on subrogation efforts
Qualification
Required
Bachelor's degree in Business Administration, Management, Economics, Accounting, or related field (or equivalent combination of work experience and education)
Minimum 10+ years' workers' compensation claims experience with specific experience managing and resolving major claims losses
Required to receive certification that meets the minimum standards of training, experience and skill
Maintain state Workers' Compensation License, as required
Preferred
Continuing education designations (CPCU, AIC, etc.) or other industry licensing and training programs
Benefits
Competitive benefits package
Generous medical, dental, and vision plans
401K retirement plans and company match
Bonus potential for all positions
Paid Time Off
Paid holidays throughout the calendar year
We’ll support you 100%
Company
ICW Group
ICW Group Insurance Companies is a top-tier, national, multi-line Property & Casualty insurance company, providing comprehensive coverage to safeguard our customers’ world.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Rob deViere
Vice President, Head of Distribution & Marketing
Iva Yuan
Chief Actuary, Head of Reserving, Pricing and Product
Recent News
2025-10-09
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