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Senior Claims Examination Specialist
2 months ago
Job Category :
Workers' Compensation Claims
Requisition Number :
CLAIM007236
Employment Type:
Full-Time
Salary Range:
$65,220.24 USD to $109,989.53 USD
Location:
Remote/Hybrid options available for qualified candidates.
The Senior Claims Examination Specialist is responsible for managing a diverse portfolio of claims, ensuring exceptional service delivery to policyholders while adhering to ICW Group's standards and best practices.
The role requires a proactive approach to resolving claims, utilizing a comprehensive understanding of insurance principles and legal frameworks, supported by legal counsel to achieve favorable outcomes.
Key Responsibilities:
- Oversee all facets of complex claims management.
- Engage effectively with policyholders, agents, legal representatives, and witnesses to collect necessary information and deliver superior customer service.
- Conduct thorough investigations to assess claim exposure, collaborating with experts to formulate strategic recommendations.
- Employ suitable resolution strategies, including mediation, negotiation, or litigation, to drive optimal results.
- Ensure compliance with state regulations and internal claims handling protocols.
- Guide legal counsel throughout litigation in accordance with ICW Group's guidelines while monitoring associated costs.
Additional Duties:
- Provide exceptional customer service consistently.
- Collaborate with cross-functional teams for project and process enhancement discussions.
- Serve as a Subject Matter Expert within the department.
- Recommend process improvements and the adoption of industry best practices.
- Ensure data accuracy in claims systems for regulatory compliance.
- Facilitate knowledge sharing across the organization.
- Pursue ongoing professional development through training and awareness of current case law.
- Mentor and train junior team members.
- Prepare and present claims status reports to stakeholders.
- Administer timely benefits to injured workers, ensuring compliance with state regulations and internal policies.
- Timely adjust reserves to align with company policies.
- Resolve claims equitably, prioritizing the interests of the insured while ensuring compliance with legal obligations.
Qualifications:
- Bachelor's degree from an accredited institution or equivalent experience, along with a minimum of 5 years in claims management.
- Certifications that meet industry standards are preferred, such as WCCA and WCCP.
Knowledge and Skills:
- Strong understanding of relevant laws and jurisdictional limitations.
- Excellent verbal communication, time management, attention to detail, and organizational skills.
- Ability to analyze and interpret technical documents, financial reports, and legal texts.
- Proficient in writing reports, business correspondence, and procedural documentation.
- Capability to address inquiries from customers and regulatory bodies effectively.
- Skilled in presenting information to management and clients.
- Adept at adapting to new technologies and embracing change.
Compensation:
The salary range for this position is $65,220.24 to $109,989.53, exclusive of benefits and potential bonuses. Final compensation will be determined based on individual qualifications, including experience and education.
Why ICW Group?
- Engaging work that allows for impactful contributions.
- A supportive environment that values employee input and fosters a sense of belonging.
- Comprehensive benefits package, including medical, dental, and vision coverage, along with 401K plans and company matching.
- Potential for bonuses across all roles.
- Generous Paid Time Off policy.
- Commitment to ongoing learning and professional development.
ICW Group is dedicated to creating a diverse workplace and is proud to be an Equal Opportunity Employer.
