Medical Only Examiner I

Are you looking for more than just a job? Do you want to have a voice and feel a sense of belonging? At ICW Group, we hire innovative people who consistently adapt, grow and deliver. We believe in hard work, a fun work environment, and embracing creativity that only comes about when talented people collaborate to develop solutions. Our mission is 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 seven consecutive years as a Top 50 performing P&C company offering the stability of a large, profitable and growing company combined with a small-company entrepreneurial spirit. Our purpose-driven ethos provides team members with opportunities to contribute, develop, and belong. 

PURPOSE OF THE JOB

The purpose of this job is to administer benefits in accordance with statutory and case law as well as pertinent regulations for an inventory comprised of minor injuries with no lost time. This position exists to reserve, manage, and bring Workers’ Compensation claims to an equitable conclusion within the company standards and best practices guidelines.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Receives and reviews information related to Medical Only claims.

• Communicates via mail, phone, and email with injured workers, employers, and medical providers.
• Sets up file diaries, documents follow-up care, and other claim-related activities.
• Assesses reserves appropriately and timely with authority level not to exceed $2,500.
• Reviews and responds to incoming mail, emails, telephone calls, and fax transmissions from providers and injured workers and takes actions required. 

Manages medical treatment to bring files to closure.

• Moves inventory to closure or upgrades as injuries evolve.
• Responsible for bringing files to supervisor’s attention when issues become complex.
• Supports the process by scheduling medical or testing appointments to determine appropriateness of medical care being received related to injury.
• Authorizes/certifies medical treatment in line with Utilization Review Regulations and as outlined within department UR plan.
• Identifies, investigates, and pursues subrogation cases.
• Follows up with medical providers to obtain results.
• Maintains effective communications with other departments and maintains a good working relationship with customers. 

Pays bills appropriately and timely.

• Reviews and approves or denies medical bills and returns bills with insufficient information.
• Processes bills in the bill paying and tracking system or issue for processing by others. 
• Ensures timely payment of bills to assure treatment continuity. 

SUPERVISORY RESPONSIBILITIES

This role does not have supervisory responsibilities.

EDUCATION AND EXPERIENCE

High school diploma or general education degree (GED) required. Minimum 1 year of related experience and/or training; or equivalent combination of education and experience.

CERTIFICATES, LICENSES, REGISTRATIONS

• Has to have or be willing to get immediately a Texas Workers Comp Adjusters License
• Preferrable to have California Code of Regulations, Title 10, Chapter 5, Sub Chapter 3, requires Medical Only Examiner Certification. 
• Medical Only Examiner must provide certificate from previous employer prior to employment start date. If no certification is provided, Medical Only Examiner must complete required hours within 12-month period and/or pass the Self-Insured Exam. If these requirements are not met, then ICW Group is unable to provide continued employment pursuant to Section 2592.02(b).

KNOWLEDGE AND SKILLS

Ability to read, write and comprehend simple instructions, short correspondence, and memos.

Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

Ability to read, analyze, and interpret technical journals, financial reports, or legal documents.

Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.

Ability to add, subtract, multiply, and divide using whole numbers, common fractions, and decimals. 

Ability to define problems, collect data, establish facts, and draw valid conclusions.

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.

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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 with an accrual rate of 5.23 hours per pay period (equal to 17 days per year)
•    11 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.