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 is to create the best insurance experience possible.
Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for seven consecutive years as a Top 50 performing P&C company offering the stability of a large, profitable and growing company combined with a small-company entrepreneurial spirit. Our purpose-driven ethos provides team members with opportunities to contribute, develop, and belong.
The Medical Only Examiner I will administer benefits in accordance with statutory and case law as well as pertinent regulations for an inventory comprised of minor injuries with no lost time. This position exists to reserve, manage, and bring Workers' Compensation claims to an equitable conclusion within the company standards and best practices guidelines.
WHAT YOU WILL DO
Receives and reviews information related to Medical Only claims.
- Communicates via mail, phone, and email with injured workers, employers, and medical providers.
- Sets up file diaries, documents follow-up care, and other claim-related activities.
- Assesses reserves appropriately and timely with authority level not to exceed $2,500.
- Takes actions required to respond to mail.
- Reviews and responds to incoming mail, emails, telephone calls, and fax transmissions from providers and injured workers.
Manages medical treatment to bring files to closure.
- Moves inventory to closure or upgrades as injuries evolve.
- Responsible for bringing files to supervisor's attention when issues become complex.
- Supports the process by scheduling medical or testing appointments to determine appropriateness of medical care being received related to injury.
- Authorizes/certifies medical treatment in line with Utilization Review Regulations and as outlined within department UR plan.
- Identifies, investigates, and pursues subrogation cases.
- Follows up with medical providers to obtain results.
- Maintains effective communications with other departments and maintains a good working relationship with customers.
Pays bills appropriately and timely.
- Reviews and approves or denies medical bills and returns bills with insufficient information.
- Processes bills in the bill paying and tracking system or issue for processing by others.
WHAT YOU BRING TO THE ROLE
- High school diploma or general education degree (GED); or equivalent combination of education and experience.
- Texas Adjustors License Required
WHY JOIN ICW GROUP?
- A flexible work schedule, hybrid and remote opportunities
- Challenging work and the ability to make a difference
- You will have a voice and feel a sense of belonging
- We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans
- Want to continue learning? We'll support you 100%
ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law.