Triage Claims Associate

Triage Claims Associate page is loaded## Triage Claims Associate locations:
San Diego, CA:
Las Vegas, NV:
Pleasanton, CA:
Lisle, IL:
Sacramento, CAtime type:
Full time posted on:
Posted Yesterday job requisition :
JR101111

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!
** PURPOSE OF THE JOB
** The Triage Claims Associate for Workers’ Compensation plays a critical role in the initial assessment and routing of a claim. This position is responsible for reviewing incoming claims to determine the severity and urgency, as well as follow up actions needed by gathering all necessary information and initiating the 3-points of contact during the first 10 days in the life of assigned claims.  

This role ensures claims files are accurate and complete prior to their transfer to the indemnity claims team.

A key objective of this role is to equip the Associate with the knowledge, skills, and abilities necessary to effectively manage a caseload of 70+ files and successfully complete either the SIP exam or earn the Claims Examiner designation within one year of hire for California. Additional Workers’ Compensation licensing may be required for other jurisdictions, as applicable.
** ESSENTIAL DUTIES AND RESPONIBILITIES
*** Reviews and analyzes incoming workers' compensation claims to determine the severity of the claims, benefits owed, ensures medical treatment is communicated to the injured worker, and reviews the claims file for completeness and accuracy of details.
* Communicates with injured workers, employers, medical providers, and internal teams to gather initial information.
* Documents claim details and triage decisions in the claims management system.
* Identifies potential fraud indicators and escalates as needed.
* Maintains compliance with company policies and state regulatory requirements.
* Supports continuous improvement initiatives within the triage process.
** SUPERVISORY RESPONSIBILITIES
** This role does not have supervisory responsibilities
** EDUCATION AND EXPERIENCE
*** High school diploma or equivalent required. Associate or Bachelor’s degree preferred.
* Minimum 1+ year of related office or customer service experience.
* Prior Workers’ Compensation industry experience highly preferred.
** KNOWLEDGE AND SKILLS
*** Basic understanding of workers compensation terminology and claims processes (preferred).
* Strong organizational and communication skills.
* Adept at computer use including proficiency with on-line databases and/or claims management software (CXP or related) and Microsoft Office Suite.
* Ability to work in a fast-paced, detail-oriented environment.
* Strong analytical skills and demonstrated attention to detail.
* Must have  good time management skills and follow through on deliverables.
* Collaborative with a team orientation and works with a sense of urgency for execution of deliverables.
** 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 frequent use of a computer, telephone, copier, and other standard office equipment.#LI-ET1 #LI-Hybrid The current range for this position is $22.54 - $35.54

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.
* 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…