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Senior Workers' Compensation Claims Examiner (Pleasanton)

Company: Insurance Company of the West
Location: Pleasanton
Posted on: May 26, 2023

Job Description:

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 Senior Claims Examiner will administer benefits to injured workers in accordance with statutory and case law as well as pertinent regulations. This position exists to independently reserve, manage, and bring complex Workers' Compensation claims to an equitable conclusion within the Company standards and best practices guidelines. The Claims Examiner will also oversee and delegate work to the Claim Assistants to ensure timely responses are made and that the work is accurate.WHAT YOU WILL DOManages a complex claim inventory nationwide.Effectively communicates with insureds, agents, attorneys, and witnesses to gather information and provide the highest possible level of customer serviceFrontloads investigations and moves with urgency by gathering information quickly to assess risk accuratelyNavigates the legal system with counsel and builds rapport with opposing counselInvestigates each claim to determine exposure and works with appropriate experts as neededEscalates claim summaries and makes strategic recommendations for approvalUtilizes the appropriate resolution tactic (such as mediation, negotiation, denial, litigation or offer) for each claim to drive strong outcomesOperates within the requirements of the Department of Insurance rules and regulations as well as internal claims handling policies and proceduresInvestigates and gathers necessary information in order to settle assigned claims.Conducts timely and thorough investigations of claims and makes assignments to independent adjusters and attorneys, where appropriateDirects defense counsel throughout the litigation process while monitoring legal fees and costsPrioritizes early resolution options for every claim and attends resolution proceedingsCreates and adjusts reserves in a timely manner to ensure reserving activities are consistent with company policiesADDITIONAL RESPONSIBILITIES:Consistently provides the highest level of customer service in the industryEffectively collaborates with team members from various departments for project and process discussionsEnsures accuracy of data in claims system for compliance with applicable regulatory reportingAdministers benefits to injured workersEnsures appropriate referral to preferred vendor partners to comply with cost containment procedures to reduce overall claim costsWHAT YOU BRING TO THE ROLEBachelor's degree from an accredited institution OR equivalent education with 5+ years of related claims experience.5+ years of related workers' compensation claims experience.CERTIFICATES, LICENSES, REGISTRATIONSCertification that meets the minimum standards of training, experience, and skill required.WCCA and WCCP preferred.State Workers Compensation License is required in some branches.KNOWLEDGE AND SKILLSThorough understanding of laws and jurisdictional restraints to manage claims.Excellent verbal communication skills, time management, attention to detail and organizational skills required.Ability to read, analyze, and interpret technical journals, financial reports, and legal documents.Ability to write reports, business correspondence, and procedure manuals.Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.Ability to effectively present information to management, public groups, and/or boards of directors.Must be adept at learning new technology and embrace change.COMPENSATIONThe salary range listed for this position, $65,220.24 to $109,989.53, is exclusive of fringe benefits and potential bonuses. If hired at ICW Group, your final base salary compensation will be determined by factors such as skills, experience and/or education. In addition, we believe in the importance of pay equity and consider internal equity of our current team members as part of any final offer. We typically do not hire at the maximum of the range in order to allow for future and continued salary growth. We also offer a substantial benefits package outlined below.WHY JOIN ICW GROUP?Challenging work and the ability to make a differenceYou will have a voice and feel a sense of belongingWe offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company matchBonus potential for all positionsPaid Time Off with an accrual rate of 5.23 hours per pay period (equal to 17 days per year)10 paid holidays throughout the calendar yearWant 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.

EducationPreferredHigh School or better

Keywords: Insurance Company of the West, Pleasanton , Senior Workers' Compensation Claims Examiner (Pleasanton), Other , Pleasanton, California

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