ICW Group’s Claims Academy Training Program prepares aspiring professionals for a career as a Claims Examiner in the Worker’s Compensation Industry. We are seeking energetic, customer focused individuals with a passionate desire to help others and who are looking to begin an exciting new career.
Trainees will go through a 10-week intensive Work Comp Claims development program and a nine-month internship. Upon successful completion, they will move into a Claims Examiner Role where they will be managing claims and providing benefits to injured workers.
PURPOSE OF THE JOB
The purpose of this job is to learn how to administer benefits to injured workers in accordance with the Labor Code. It exists to learn how to maintain and handle Worker’s Compensation Claims within the Company standards and best practices guidelines.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Learn how to investigate and gather necessary information to process and settle claims
Develop skills to be able to communicate with insureds to obtain information necessary for processing claims. Contact and/or interview injured workers, medical specialists or employers to obtain necessary information to manage a claim.
Develop skills to be able to assist legal counsel to ensure timely and cost effective litigation. Gain an understanding of when to refer to legal counsel.
Develop skills to examine results of investigations completed by outside investigators and what additional action should be taken on questionable claims to determine if benefits are owed.
Develop skills to be able to pursue subrogation, recoveries and contributions vigorously and within statutory timeframes.
Gain technical knowledge to ensure the fair and prompt management of cases
Develop the skills to be able to present cases and participate in their discussion at claim committee meetings.
Develop the skills to be able to create and adjust reserves in a timely manner to ensure reserving activities are consistent with company policies.
Develop the skills to be able to manager and approve payment of benefits within the designated authority level.
Develop the skills to resolve claims fairly and equitably within authority, acting in the best interest of the insured
Learn when and how to report overpayments, underpayments and other irregularities.
Assist in the operational and administrative duties for the Claims department
Develop the skills to administer benefits to injured workers.
Participate in claim reviews and service calls with insured and prospective insureds when requested.
Learn to ensure accuracy of data in claims system for compliance with applicable regulatory reporting.
Understand how to ensure appropriate referral to preferred vendor partners to comply with cost containment procedures to reduce overall claim cost.
Learn how communicate effectively with other company departments and maintain a good working relationship with insureds, employers and agents.
Review and understand the medical aspects of claims management
Develop knowledge of medical terminology.
Learn the various types of diagnostic studies and how they are utilized
Understand the most common work injuries
Gain an understanding of the AMA guides and how to apply this knowledge
This role does not have supervisory responsibilities.
EDUCATION AND EXPERIENCE
High School diploma or general education degree (GED) required. Bachelor’s degree from a four-year college or university preferred.
CERTIFICATES, LICENSES, REGISTRATIONS
All examiners must receive certification that meets the minimum standards of training, experience and skill. State Worker’s Compensation license is required in some branches.
KNOWLEDGE AND SKILLS
Excellent verbal and written communication skills, time management and organizational skills. Requires a high level of attention to detail. Must have a sense of urgency for execution.
Office environment – no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear.
This position maps to the Individual Contributor level. Additional competencies required: none.
This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment.
If you have sophisticated interpersonal skills that project a sense of optimism, “can-do” spirit, and fun with the ability to adapt depending on situations, then we would love to talk to you!
About ICW Group
Based in San Diego, ICW Group Insurance Companies is the largest group of privately held insurance companies domiciled in California. Quoting more than $3 billion annually, ICW Group represents a group of Property, Auto and Workers’ Compensation insurance carriers, including Insurance Company of the West and Explorer Insurance Company.
ICW Group is recognized nationally as an industry leader in helping policyholders achieve fewer and less costly claims, and is committed to meeting the needs of its policyholders and elevating the trusted agents and brokers who advise them. The company offers its insurance products through an independent network of experienced and professional agents and brokers.