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Claims Associate Jobs in Fallbrook, CA (NOW HIRING)

ICW Group

Triage Claims Associate

San Diego, CA · On-site

$18.75 - $25.50/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

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 ...

Icwgroup

Triage Claims Associate

San Diego, CA · Hybrid

$18.75 - $25.50/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

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 ...

New

ICW Group

Triage Claims Associate

San Diego, CA · On-site

$18.75 - $25.50/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

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 ...

New

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Claims Associate information

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How much do claims associate jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for claims associate in Fallbrook, CA is $22.00, according to ZipRecruiter salary data. Most workers in this role earn between $17.88 and $24.18 per hour, depending on experience, location, and employer.

What does a claims associate do?

A claims associate handles claims for an insurance company. As a claims associate, your job duties may include reviewing a customer’s insurance coverage and interviewing those who have filed a claim. Your job is to ensure that a claim is processed correctly, so the customer receives the financial payout to which they are entitled. In this career, you usually work in an office, but you may need to travel to gather information about the claim. There are positions in every insurance industry so that you may work in anything from auto to life insurance. This position requires excellent research and interpersonal skills, and experience in customer service is a plus. Additional qualifications may include an associate degree.

What is the difference between Claims Associate vs Claims Examiner?

AspectClaims AssociateClaims Examiner
Required CredentialsHigh school diploma or equivalent; some roles may prefer insurance-related certificationsHigh school diploma; insurance certifications like CPCU or similar beneficial
Work EnvironmentOffice setting, interacting with customers and internal teamsOffice setting, reviewing claims and documentation
Employer & Industry UsageInsurance companies, third-party administratorsInsurance companies, adjusting departments
Common Search & ComparisonClaims Associate vs Claims Examiner

The main difference between a Claims Associate and a Claims Examiner lies in their responsibilities. Claims Associates typically handle initial customer interactions and basic claim processing, while Claims Examiners review and assess claims in detail, often making determinations on claim validity. Both roles require similar credentials and work in comparable environments, but Claims Examiners usually have more specialized knowledge and decision-making authority.

What are the key skills and qualifications needed to thrive as a claims associate?

To thrive as a Claims Associate, you need a solid understanding of insurance policies, attention to detail, and basic analytical skills, usually supported by a high school diploma or equivalent. Familiarity with claims management systems, CRM software, and sometimes industry certifications like AIC (Associate in Claims) are commonly required. Strong communication, problem-solving, and customer service abilities set top performers apart. These skills are essential for accurately processing claims, ensuring compliance, and providing a positive experience for clients and policyholders.

What does a claims associate do?

A Claims Associate is responsible for reviewing, processing, and managing insurance claims submitted by policyholders. Their duties include verifying information, evaluating the validity of claims, and ensuring all necessary documentation is complete. They often communicate with customers, healthcare providers, or other parties to gather additional information and resolve any issues. Claims Associates play a crucial role in ensuring claims are processed accurately and efficiently according to company policies and regulatory guidelines.

What are some common challenges a claims associate may face, and how can they effectively handle them?

Claims Associates often encounter challenges such as managing a high volume of claims, navigating complex policy details, and communicating with clients who may be experiencing stress or frustration. Effectively handling these situations requires strong organizational skills, attention to detail, and clear, empathetic communication. Many Claims Associates find success by proactively prioritizing tasks, seeking guidance from senior team members when needed, and utilizing available technology to streamline documentation and follow-ups.
More about Claims Associate jobs

What are the most commonly searched types of Claims jobs in Fallbrook, CA?

The most popular types of Claims jobs in Fallbrook, CA are:

What cities near Fallbrook, CA are hiring for Claims Associate jobs?

Cities near Fallbrook, CA with the most Claims Associate job openings:

Claims Associate jobs near you
Infographic showing various Claims Associate job openings in Fallbrook, CA as of July 2026, with employment types broken down into 65% Full Time, 32% Part Time, 1% Temporary, and 2% Contract. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution, with an average salary of $45,754 per year, or $22 per hour.

Triage Claims Associate

ICW Group

San Diego, CA • On-site

$18.75 - $25.50/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 4 days ago

Job description

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!
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.
We are currently not offering employment sponsorship for this opportunity.
#LI-NT1
#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.
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
  • 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.
Job Category
Claims

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