Senior Manager Claims

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!

JOB SUMMARY

The Senior Manager of Claims is responsible for leading strategic initiatives that ensure regulatory compliance, operational efficiency, and superior claim outcomes. This role leverages data-driven insights to optimize processes, mitigate risk, and enhance customer experience nationally, across all lines of business. The Senior Manager will focus on specific areas within claims such as Audit, Compliance, and Claims Support.   

ESSENTIAL DUTIES AND RESPONSIBILITIES

Provide Strategic Leadership, Data Driven Decision Making, Operational Efficiencies and Customer Focus.

• Develop and execute strategies that align audit, compliance, technical claims management, and support functions with organizational goals for claims performance.

• Drive initiatives that improve claim outcomes through process optimization and risk mitigation.

• Establish metrics and KPIs to measure performance, operational efficiency, and compliance effectiveness.

• Leverage analytics and reporting tools to identify trends, gaps, and opportunities for improvement.

• Translate data insights into actionable strategies for claims operations.

• Streamline workflows and eliminate redundancies.

• Implement automation and technology solutions to enhance productivity and reduce cycle times.

• Monitor resource allocation and optimize team performance.

• Ensure that operational procedures support excellent customer experience while maintaining compliance and accuracy standards.

• Collaborate with claims teams to resolve escalated issues promptly and effectively.

• Identify and mitigate operational, compliance, and reputational risks related to claims handling.

• Maintain robust internal controls and ensure timely remediation of audit findings.

Collaborate with internal stakeholders to address claims issues and trends.

• Communicate consistently with the Claims Leadership team regarding claims management, policies, procedures, audits, reports, and projects associated with claims handling and operational activities.

• Partner with senior leadership to resolve claim issues and trends related to legal/medical providers or other external constituencies.

• Analyze operational/system issues and claims exposures, as applicable, to submit to senior leadership along with recommendations.

• Review reports/data to identify and address adverse trends and manage budget expenditures. Create and delivers regular reports on operating metrics to Claims leadership.

Lead and develop a team to provide best-in-class customer service.

• Provide team leadership, development and mentoring.

• Provide strategic and tactical direction to team(s), communicating Mission, Values, and other organization operating principles.

• Establish and maintain the overall work cadence, ensuring performance and outcomes strive for excellence in delivery and customer experience. Ensure full team engagement and leadership practices that promote and support professional development, recognition, and retention.

• Establish hiring criteria, on-boarding, and training requirements for new team members.

• Oversee the performance management and development process and perform performance management duties, development planning, and coaching for direct reports.

• Ensure data quality, adherence to IT security guidelines, profitability and other risk-related metrics for self and team members.

• Manage team budgets, technology, workload, and customer inquiries for branches. Ensure adherence to all Company policies and procedures and compliance accountabilities and responsibilities.

Audit & Compliance Oversight

• Ensure adherence to regulatory requirements, internal policies, and industry standards.

• Design and implement audit frameworks to monitor claims accuracy, fraud prevention, and compliance.

• Report findings and recommend corrective actions to senior leadership.

• Ensure accurate and timely preparation, validation, and submission of reinsurance reports in compliance with contractual and regulatory requirements. Collaborate with claims and finance teams to resolve discrepancies and maintain data integrity.

• Manage regulatory EDI reporting requirements across all applicable jurisdictions, ensuring compliance with IAIABC standards, state-specific implementation guides, and timely submission of required forms and agreements.

Support Services Oversight

• Ensure accurate and timely administrative support for claims operations. Provide guidance and foster a culture of accountability and continuous improvement.

• Monitor daily workflows and processes to maintain efficiency, consistency, and compliance with company standards. Ensure deadlines are met and quality benchmarks are achieved across all support activities.

• Manage resources effectively to support departmental needs and maintain service levels.

• Handle escalated inquiries and resolve complex issues promptly.

SUPERVISORY RESPONSIBILITIES

Directly supervises a team. Fulfills supervisory responsibilities in accordance with the organization’s policies and applicable laws.  Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems; coaching, mentoring, and developing team members to further their skills and knowledge; creating and monitoring development plans; setting performance expectations and goals; forecasting staffing needs and planning for peak times frames and absences; enforcing department policies and procedures.

EDUCATION AND SKILLS

• Bachelor’s degree required in Business Administration, Management, or related field (or equivalent combination of education and experience).

• Minimum 5+ years’ related claims experience required.

• Minimum 3 years’ experience leading and supervising claims professionals.

• Experience with diverse jurisdictions and multiple lines of business is highly desirable.        

CERTIFICATES, LICENSES, REGISTRATIONS

• Adjuster Certification may be required depending upon role and jurisdiction. 

• Insurance Education Association (IEA) Certificate, Workers’ Compensation Claims Professional (WCCP) accreditation preferred.

• Chartered Property Casualty Underwriter (CPCU) designation a plus.

KNOWLEDGE AND SKILLS

• Good understanding of national commercial insurance regulations and standards across all lines of business.

• In-depth knowledge of Medicare regulations and compliance standards impacting all commercial lines of business.

• Strong analytical skills with experience in data-driven decision-making.

• Proven ability to lead teams and manage complex projects.

• Excellent communication and stakeholder management skills.

• Knowledge of Scaled Agile Framework (SAFe) or Lean-Agile methodology is preferred.

• Familiarity with automation tools and process improvement practices.

• Advanced proficiency in data analytics and reporting tools.

• Knowledge of requirements for NCCI, WCIRB, and other specific State reports such as WCIS or DWC’s.

• Advanced understanding of Workers’ Compensation, Property or Liability Claims principles and application.

• Strong understanding of personnel and performance strategies.

• Excellent time management and organizational skills.

• Strong understanding of insurance claims principles, process improvement methodologies and practices with direct experience in a support role.

PHYSICAL REQUIREMENTS

Office environment – no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear.  The employee may need to sit in front of a computer for a period. While performing the duties of this job, the employee may occasionally need to reach, stoop, kneel, crouch, or crawl. The employee may need to lift and/or move up to twenty-five pounds.

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 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.

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