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ICW Group · 8 hours ago

Major Claims Examiner

San Diego, CA

Full-time

Onsite

Senior Level, Lead/Staff

$91K/yr - $153K/yr

10+ years exp

ICW Group is a well-established insurance company that has been in business for over 50 years. They are seeking a Major Claims Examiner who will manage complex workers’ compensation claims, ensuring timely and fair resolutions while reducing financial exposure and supporting injured workers' recovery.

Financial ServicesInsurance

Growth Opportunities

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

Applies technical knowledge and human relations skills to ensure fair and prompt management of cases

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

Reduces And Mitigates Company’s Financial Exposure

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

Workers' compensation claimsClaims handling systemsMulti-jurisdictional lawsNegotiationCritical thinkingCommunication skillsTime managementOrganizational skillsMentoring

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

Expert knowledge of complex claims principles and practices

Proficiency in claims handling systems, analytics tools, and databases

Strong understanding of multi-jurisdictional laws

Ability to apply technical knowledge and human relations skills to ensure fair and prompt management of cases

Skilled in negotiation, strategic decision-making, and mentoring

Advanced critical thinking skills and attention to detail

Excellent verbal and written communication skills, time management, and organizational skills required

Preferred

Continuing education designations (CPCU, AIC, etc.) or other industry licensing and training programs

Benefits

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

Glassdoor4.0

ICW Group Insurance Companies is a top-tier, national, multi-line Property & Casualty insurance company, providing comprehensive coverage to safeguard our customers’ world.

Founded in 1972

San Diego, California, USA

1001-5000 employees