Senior Claims Examination Specialist
1 week ago
Are you seeking a fulfilling career where your contributions are valued? At ICW Group, we prioritize innovation and adaptability in our workforce. We foster a dynamic work environment that encourages creativity and collaboration to deliver exceptional solutions. Our mission is to provide an unparalleled insurance experience.
ICW Group, headquartered in San Diego with regional offices across the United States, has been recognized as a Top 50 performing P&C company for seven consecutive years. We combine the stability of a large, successful organization with the entrepreneurial spirit of a smaller company. Our purpose-driven culture offers team members opportunities to contribute, grow, and feel a sense of belonging.
The Senior Claims Examination Specialist is responsible for managing moderate to complex claims, ensuring the highest level of service for policyholders while bringing claims to a fair resolution in accordance with company standards and best practices. This role requires a sense of urgency, a solid understanding of insurance coverage concepts, and the ability to navigate the legal landscape with counsel support to achieve strategic outcomes.
Key Responsibilities:
Manage all facets of a complex claims portfolio.
- Communicate effectively with policyholders, agents, attorneys, and witnesses to gather essential information and deliver superior customer service.
- Conduct prompt investigations to assess exposure, collaborating with experts to make informed recommendations.
- Employ suitable resolution strategies (e.g., mediation, negotiation, denial, litigation, or settlement) to achieve optimal results.
- Adhere to state regulations and internal claims handling policies throughout the claims process.
- Oversee defense counsel during litigation, ensuring compliance with ICW litigation guidelines while monitoring legal expenses.
- Provide exceptional customer service consistently.
- Collaborate with cross-departmental team members for project discussions and process improvements.
- Serve as a Subject Matter Expert within the department.
- Recommend process enhancements and implement industry best practices.
- Ensure data accuracy in the claims system for regulatory compliance.
- Facilitate knowledge transfer across the organization.
- Continuously enhance technical skills through job-related training and staying updated on current case law.
- Mentor and train junior team members.
- Prepare and present claims status reports to stakeholders.
- Administer timely benefits to injured workers, managing payments within designated authority levels while complying with applicable regulations.
- Timely create and adjust reserves to align with company policies.
- Resolve claims equitably, acting in the best interest of the insured while ensuring timely benefits to injured workers as mandated by law.
- Bachelor's degree from an accredited institution (or equivalent education and experience) along with 5+ years of relevant claims experience.
- Certification meeting minimum training, experience, and skill standards.
- WCCA and WCCP certifications preferred.
- Strong understanding of laws and jurisdictional constraints related to claims management.
- Excellent verbal communication, time management, attention to detail, and organizational skills.
- Ability to read, analyze, and interpret technical documents, financial reports, and legal materials.
- Proficient in writing reports, business correspondence, and procedural manuals.
- Capable of addressing inquiries or complaints from customers and regulatory bodies.
- Adept at presenting information effectively in meetings with management and clients.
- Willingness to learn new technologies and adapt to change.
The salary range for this position is competitive and will be determined based on individual qualifications, including experience, education, and role location.
Why ICW Group?
- Engaging work that makes a difference.
- A supportive environment where you can express your ideas.
- Comprehensive benefits package, including medical, dental, and vision plans, along with 401K retirement plans and company matching.
- Bonus potential for all positions.
- Generous Paid Time Off accrual.
- Ten paid holidays each year.
- Commitment to ongoing learning and development.
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