Workers Compensation Claims Specialist

4 weeks ago

Orange, California, United States Intercare Insurance Full time
Job Description

Job Summary:

As a Workers Compensation Claims Specialist at Intercare Insurance, you will be responsible for managing an assigned inventory of claim files, including cases of extreme complexity or with unique issues. You will work closely with the Claims Supervisor and medical case manager to maximize early return to work potential and reduce the need for extended disability payments.

Key Responsibilities:

  • Perform a three-point contact on all new losses within 24 hours to document relevant facts and disability status.
  • Thoroughly document ongoing case facts and relevant information for establishing compensability and resolving the claim.
  • Develop and maintain up-to-date plans of action for assigned indemnity claims.
  • Partner with the medical case manager to maximize early return to work potential.
  • Initiate referrals to the Special Investigations Unit (SIU) for cases with suspected fraud.
  • Pursue subrogation from culpable third parties and contributions on multiple defendant cases.
  • Ensure claim files are handled in accordance with applicable statutes and company guidelines.
  • Review and approve vocational rehabilitation plans.
  • Establish and adjust monetary case reserves as needed.
  • Review medical bills for appropriateness prior to referral to InterMed for payment.
  • Exhibit a courteous and helpful attitude and project a professional image on behalf of the company.
  • Respond to telephone messages and inquiries within 24 hours and written inquiries within one week.

Requirements:

To perform this job successfully, you should demonstrate the following competencies:

  • Problem Solving - Identify and resolve problems in a timely manner, gather and analyze information skillfully, develop alternative solutions, and use reason even when dealing with emotional topics.
  • Customer Service - Manage difficult or emotional customer situations, respond promptly to customer needs, respond to requests for service and assistance, and meet commitments.
  • Interpersonal - Focus on solving conflict, not blaming, maintain confidentiality, listen to others without interrupting, keep emotions under control, and remain open to others' ideas and try new things.
  • Team Work - Support everyone's efforts to succeed.

Qualification Requirements:

To perform this job successfully, you must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:

Bachelor's degree (B.A.) from a four-year college or university, at least seven years related experience and/or training, or an equivalent combination of education and experience. Requires a high degree of claims handling expertise, including a minimum of five years experience managing indemnity cases, many with complex or high potential subrogation, rehabilitation, medical management, and/or legal issues, and possess an SIP certificate.

  • Insurance Claims Specialist

    3 weeks ago

    Orange, California, United States Sedgwick Claims Management Services Full time

    To excel as a skilled industry professional, you will be trained to analyze workers compensation, general liability, or disability claims and determine benefits due. Key responsibilities include:Essential Functions:Attend and complete designated training programs.Develop expertise in workers compensation, general liability, and disability claims.Apply...

  • Claims Resolution Specialist

    4 weeks ago

    Orange, California, United States Sedgwick Claims Management Services Full time

    Job SummaryTo succeed in this role, you will be oriented and trained as a new industry professional with the ability to analyze workers compensation, general liability, or disability claims and determine benefits due.Essential Functions:Attend and complete designated training programs to develop industry knowledge and skills.Analyze claims data to determine...

  • Workers Compensation Claims Handler

    4 weeks ago

    Orange, California, United States Sedgwick Full time

    Job SummaryWe are seeking a skilled Workers Compensation Claims Handler to join our team in California. As a Claims Handler, you will be responsible for analyzing and processing claims to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.Key...

  • Workers' Compensation Defense Attorney

    4 weeks ago

    Orange, California, United States W3Global Inc Full time

    Job OverviewW3Global Inc is seeking an experienced Workers' Compensation Defense Attorney to join our team in Orange County, CA.The ideal candidate will have a strong background in workers' compensation law and be able to handle all aspects of defending workers' compensation claims for benefits, including medical, disability, impairment, increased benefits...

  • Claims Operations Specialist

    3 weeks ago

    Orange, California, United States Intercare Insurance Services Full time

    Job Summary:As a Claims Operations Specialist at Intercare Insurance Services, you will report directly to the Claims Supervisor and take primary direction for assigned Claims Specialists. Your primary responsibility will be to provide clerical operations support to assigned Claims Specialists.This role requires a high school diploma or equivalent, with 1-2...

  • Claims Assistant

    3 weeks ago

    Orange, California, United States Intercare Insurance Services Full time

    Job Title: Workers Compensation Claims AssistantJob Summary: We are seeking a highly organized and detail-oriented Claims Assistant to join our team at Intercare Insurance Services. The successful candidate will provide clerical operations support to our Claims Specialists, ensuring seamless claims processing and exceptional customer service.Key...

  • Senior Workers Compensation Defense Attorney

    2 days ago

    Orange, California, United States Orange, California Full time

    About Our OpportunityWe are seeking a highly skilled Senior Workers Compensation Defense Attorney to join our team in Orange, California.Salary:$125,000 - $175,000 per yearJob DescriptionAs a Senior Workers Compensation Defense Attorney, you will be responsible for defending clients against workers' compensation claims. This is a fast-paced environment that...

  • Claims Assistant

    4 weeks ago

    Orange, California, United States Intercare Insurance Full time

    Job Title: Workers Compensation Claims AssistantIntercare Insurance is seeking a highly organized and detail-oriented Workers Compensation Claims Assistant to join our team.The ideal candidate will have excellent communication skills, be able to work independently, and have a strong understanding of workers compensation laws and regulations.Key...

  • Claims Support Specialist

    4 weeks ago

    Orange, California, United States Sedgwick Full time

    Sedgwick is committed to providing exceptional support to our valued colleagues, and we're seeking a Claims Support Specialist to join our team.This role is an exciting opportunity to contribute to our culture of caring, where you'll have the flexibility to balance your work and personal life.As a Claims Support Specialist, you'll play a vital role in...

  • Claim Representative

    4 weeks ago

    Orange, California, United States Sedgwick Full time

    About the RoleWe are seeking a highly motivated and detail-oriented Claim Representative to join our team at Sedgwick. As a Claim Representative, you will be responsible for analyzing workers compensation, general liability, or disability claims and determining benefits due. This is an excellent opportunity to develop your skills and knowledge in claims...

  • Claim Representative

    4 weeks ago

    Orange, California, United States Sedgwick Full time

    Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your...

  • Workers' Compensation Defense Attorney

    3 weeks ago

    Orange, California, United States Jobot Full time

    Job DetailsJobot, a 130M+ multi-service litigation firm, is seeking a 100% remote Workers' Compensation Defense Attorney. This role involves defending clients in workers' compensation cases. The ideal candidate will have a JD from an approved law school, a minimum of 1 year of experience practicing in Workers' Compensation Defense, and an active CA bar...

  • Claims Specialist

    4 weeks ago

    Orange, California, United States Sedgwick Full time

    Job SummaryAs a Claims Assistant at Sedgwick, you will play a vital role in supporting our claims staff and performing various office tasks. This is an excellent opportunity to join a dynamic team and contribute to the success of our organization.Key Responsibilities* Set up and enter new claims into our claims management system* Input and review...

  • Pastoral Support Worker

    4 weeks ago

    Orange, California, United States Doncaster Council Full time

    Job Title: Pastoral Support WorkerJob Summary: We are seeking a highly motivated and inspirational individual to join our expanding Pastoral Team as a Pastoral Support Worker.Key Responsibilities:Provide early intervention to situations on site before they become bigger issues.Offer support and guidance to young people with specialist communication...

  • Medical Claims Specialist

    4 weeks ago

    Orange, California, United States AmeriPharma Full time

    About AmeriPharmaAmeriPharma is a rapidly growing healthcare company that offers a unique opportunity to contribute to our collective success every day. We value innovation, creativity, and productivity, and we seek individuals who are passionate about their roles and eager to grow as the company evolves.AmeriPharma's BenefitsA comprehensive benefits package...

  • Reimbursement Specialist

    3 weeks ago

    Orange, California, United States AmeriPharma Full time

    Job OverviewAmeriPharma is seeking a highly skilled Reimbursement Specialist to join our team. As a Reimbursement Specialist, you will be responsible for accurate and timely claims reimbursement activities, including interactions with third-party payers and patients, as well as maintaining accurate records.Key ResponsibilitiesReviews patient inventory of...

  • Daily Property Field Adjuster

    4 weeks ago

    Orange, California, United States Alacrity Solutions Full time

    Job DescriptionAlacrity Solutions is a leading provider of insurance claims services, delivering streamlined solutions for property, auto, heavy equipment, and casualty claims management. As an independent contractor, you will work as a Daily Property Field Adjuster, providing excellent claim handling services for our clients.Key Responsibilities:Provide...

  • Clinical Social Worker

    1 month ago

    Orange, California, United States California Correctional Health Care Services Full time

    Job Title: Clinical Social Worker - Telemental Health SpecialistCalifornia Correctional Health Care Services is seeking a highly skilled Clinical Social Worker to join our Telemental Health team. As a Clinical Social Worker, you will conduct assessments of inmates within the California Department of Corrections and Rehabilitation (CDCR) via...

  • Reimbursement Specialist

    4 weeks ago

    Orange, California, United States AmeriPharma Full time

    Job SummaryAmeriPharma is seeking a highly skilled Reimbursement Specialist to join our team. As a Reimbursement Specialist, you will be responsible for accurate and timely claims reimbursement activities, including interactions with third-party payers and patients, as well as maintaining accurate records.Key ResponsibilitiesReviews patient inventory of...

  • Senior Compensation Specialist

    3 weeks ago

    Orange, California, United States Orange Unified School District Full time

    **Job Summary**Orange Unified School District is seeking a highly skilled Senior Compensation Specialist to join our team. In this role, you will be responsible for overseeing the district's compensation program, ensuring that it is fair, equitable, and compliant with all relevant laws and regulations.Key Responsibilities:Develop and implement compensation...