Major Claims Examiner

* 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.
* 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.
* 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.
* Challenging work and the ability to make a difference
* You will have a voice and feel a sense of belonging

At ICW Group we offer a work environment that encourages entrepreneurialism and celebrates success.  Our team members are hands-on contributors who are given the opportunity to make an impact.  It's our people who make us an employer of choice and the vibrant company we are today.
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