Claims Specialist

91367, Woodland Hills

 

Are you looking for more than just a job? Do you want to have a voice and feel a sense of belonging? At ICW Group, we hire innovative people who consistently adapt, grow and deliver. We believe in hard work, a fun work environment, and embracing creativity that only comes about when talented people collaborate to develop solutions. Our mission to create the best insurance experience possible.

ICW's Corporate Services team is comprised of smart, motivated, and talented individuals who are passionate about customer service. The team is highly supportive of each other. Our culture is driven by collaboration and great camaraderie across the full department and company wide. Corporate Services has a best-in-class reputation.

The Claims Specialist will evaluate cases and administer benefits to injured workers in accordance with statutory and case law as well as pertinent regulations. This position exists to reserve, manage, and bring Workers' Compensation claims to an equitable conclusion within the Company standards and best practices guidelines. *We are open to considering remote candidates.

WHAT YOU WILL DO:

Investigates and gathers necessary information in order to settle assigned claims.

  • Communicates with insureds to obtain information for processing claims.
  • Confers with legal counsel on claims requiring litigation.
  • Attends depositions and hearings as often as workload allows.
  • Contacts and interviews claimants, doctors, medical specialists, and employers to get additional information.
  • Examines claims investigated by outside adjusters and further investigates questionable claims to determine whether to authorize payments.
  • Caseload includes claims with more complex issues involving continuous trauma, catastrophic injuries, structured settlements, etc.

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

  • Presents cases and participates in discussion at claim committee meetings.
  • Creates and adjusts reserves in a timely manner to ensure reserving activities consistent with company policies.
  • Manages and approves payment of benefits within designated authority level.
  • Resolves claims fairly and equitably, acting in the best interest of the insured and providing benefits as prescribed by law.
  • Reports overpayments, underpayments and other irregularities.

Assists in operational duties for the department as an expert in claims issues.

  • Provides training and mentoring to Claims Examiners as needed.
  • Participates in claim reviews and service calls with insureds and prospective insureds.
  • Pursues subrogation vigorously.

WHAT YOU BRING TO THE ROLE:

  • High school diploma or general education degree (GED), required.
  • Minimum 10 years of related experience and/or training; or, equivalent combination of education and experience.
  • All Examiners must receive certification that meets the minimum standards of training, experience, and skill.
  • State Workers Compensation License is required in some branches.

NICE TO HAVE:

  • WCCA and WCCP preferred.
  • Bachelor's degree from four-year college or university: Business, Communications, or related degree, preferred.

KNOWLEDGE AND SKILLS

Advanced understanding of laws and jurisdictional restraints to manage injuries. Excellent verbal communication skills, time management, and organizational skills. Requires a high level of attention to detail. Sense of urgency for execution. Ability to apply principles of logical to a wide range of intellectual and practical problems. Ability to lead a small unit of claims professionals.

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