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 it's 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!

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.

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 escalates as necessary.

• 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.

• 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.

This role does not have supervisory responsibilities.

• 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.

Required to receive certification that meets the minimum standards of…