Claims Specialist

This Claims Specialist is responsible for handling complex claims with a focus on providing exceptional service for stakeholders in order to drive claims to an equitable resolution within Company standards.  The Claims Specialist works with a sense of urgency, understands insurance coverage concepts, and navigates the legal system with the support of counsel to drive strategic outcomes.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Manages all aspects of a California complex claims inventory. 

• Effectively communicates with policyholders, agents, attorneys, and witnesses to gather information and provide the highest possible level of customer service.

• Promptly investigates claims to determine exposure, works with appropriate experts and makes strategic recommendations.

• Utilizes appropriate resolution tactics (e.g., mediation, negotiation, denial, litigation or offer) to proactively drive outstanding results.

• Operates within the requirements of related state and/or the governing entity rules and regulations as well as internal claims handling policies and procedures. 

• Directs defense counsel throughout the litigation process in line with ICW litigation guidelines while monitoring legal fees and costs.

Additional Responsibilities:

• Consistently provides exceptional customer service.

• Effectively collaborates with team members from various departments for project and process discussions.

• Acts as a Subject Matter Expert for the department.

• Makes recommendations for streamlining processes and adopting the industry’s best practices.

• Ensures accuracy of data in claims system for compliance with applicable regulatory reporting.

• Provides knowledge transfer across the organization.

• Continuously seeks to improve technical skills by attending job related training and tracking current case law. 

• Acts as a mentor and provides training for less experienced team members.

• Prepares and presents claims status reports for internal and external stakeholders.

• Administers timely and appropriate benefits to injured workers; manages and approves payment of benefits within designated authority level.  Works within applicable state rules, regulations as well as ICW Group’s internal claims handling policies and procedures.

• Creates and adjusts reserves in a timely manner to ensure reserving activities are consistent with company policies.

• Resolves claims fairly and equitably, acting in the best interest of the insured while providing timely benefits to injured workers as required by law. 

SUPERVISORY RESPONSIBILITIES 

This position has no supervisory responsibility but will serve as a technical leader.

EDUCATION AND EXPERIENCE 

Bachelor's degree from an accredited institution (or equivalent education and experience) along with 8-10 years of related claims experience.  

CERTIFICATES, LICENSES, REGISTRATIONS 

Workers’ Compensation: Certification 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 SKILLS

Thorough understanding of laws and jurisdictional restraints to manage injuries. Excellent verbal and written 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. Facilitates and leads meetings across a team of claims professionals for assigned projects.    

PHYSICAL REQUIREMENTS  

Office environment – no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear.  

WORK ENVIRONMENT  

This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment.