Major Claims Examiner

Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our  journey as we strive to transform the insurance  carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission 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 ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our  internal and external communities better everyday! Learn more about why you want to be here!

PURPOSE OF THE JOB

The Major Claims Examiner is responsible for managing complex, high-value workers’ compensation claims and ensuring timely, fair resolution in compliance with policy provisions while reducing financial exposure and supporting injured workers’ recovery. This position manages assigned major loss claims independently while adhering to company standards and state regulations.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Investigates and gathers necessary information to resolve assigned claims.

• Examines major and catastrophic claims to determine coverage, liability, and damages.

• Communicates with insureds to obtain information necessary for processing claims.

• Partners with legal counsel on litigation strategies while maintaining file ownership.

• Attends depositions and conferences exercising appropriate prioritization based on workload.

• Contacts and/or interview claimants, doctors, medical specialists, or employers to obtain relevant information.

• Conducts thorough investigations, including reviewing medical records, legal documents, and other supporting evidence. Directs additional investigation of questionable claims to determine compensability.

• Identifies potential fraud indicators and escalate as necessary.

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

• Manages and approves benefit payments within authority limits, ensuring compliance with state regulations and internal standards.

• Effectively communicates exposure and strategies to senior leadership.

• Resolves claims fairly and equitably, acting in the best interest of the insured and providing benefits as prescribed by law and in accordance with company standards.

• Utilizes structured settlements to resolve high exposure claims.

• Serves as a mentor and works closely with branch staff to devise strategy for reserving and settlement on high exposure claims, as requested.

• Identifies opportunities to engage with other company departments including managed care, legal, payment recovery, and SIU.

• Attends settlement mediations and conferences, as necessary.

• Participates in claim reviews and service calls with insureds and prospective insureds.

Reduces and mitigates Company’s financial exposure.

• Researches historical billing data for facilities and providers to establish accurate file reserves.

• Analyzes and reports catastrophic and major claims loss data to WCC leaders.

• Implements proactive and strategic plans to bring claims to a timely and appropriate resolution.

• Anticipates future developments and exposures and maintain accurate reserves.

• Pursues subrogation in most cases; refers and/or follows up on subrogation efforts.

SUPERVISORY RESPONSIBILITIES

This role does not have supervisory responsibilities.

EDUCATION AND EXPERIENCE

• Bachelor's degree in Business Administration, Management, Economics, Accounting, or related field (or equivalent combination of work experience and education).

• Minimum 10+ years’ workers’ compensation claims experience with specific experience managing and resolving major claims losses.

CERTIFICATES, LICENSES, REGISTRATIONS

Required to receive certification that meets the minimum standards of training, experience and skill. Maintain state Workers’ Compensation License, as required. Continuing education designations (CPCU, AIC, etc.) or other industry licensing and training programs are preferred.

KNOWLEDGE AND SKILLS

• Expert knowledge of complex claims principles and practices.

• Proficiency in claims handling systems, analytics tools, and databases.

• Strong understanding of multi-jurisdictional laws.

• Ability to apply technical knowledge and human relations skills to ensure fair and prompt management of cases.

• Skilled in negotiation, strategic decision-making, and mentoring.

• Advanced critical thinking skills and attention to detail.

• Excellent verbal and written communication skills, time management, and organizational skills required.

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.

We are currently not offering employment sponsorship for this opportunity

#LI-ET1 #LI-Hybrid

The current range for this position is

This range is exclusive of fringe benefits and potential bonuses.  If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work.

WHY JOIN ICW GROUP? 

• 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 and company match 

• Bonus potential for all positions 

• Paid Time Off

• Paid holidays throughout the calendar year 

• 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.

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