Claims Resolution Specialist
7 days ago
We are seeking a highly skilled Claims Resolution Specialist to join our team at Intercare Holdings Insurance Services, Inc.
About the RoleThis role involves effectively managing claim files from inception to closure, ensuring compliance with statutory requirements and company policies. You will be responsible for gathering evidence, establishing compensability, and resolving claims in a timely and efficient manner.
Key Responsibilities- Evidence Gathering: Conduct thorough three-point contact on all new losses within 24 hours of receipt of the claim, documenting relevant facts surrounding the incident, disability, and treatment status.
- Case Management: Gather evidence necessary for establishing compensability, disability payments, vendor usage, medical expenses, and reasons for ongoing claims.
- Indemnity Claims: Ensure assigned indemnity claims have up-to-date plans of action outlining activities and actions for resolving claims.
- Medical Case Management: Partner with medical case managers to maximize early return-to-work potential, reducing extended disability payments and protracted claims costs.
- Fraud Investigation: Initiate referrals to SIU for cases suspected of fraud.
- Subrogation and Apportionment: Pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre-existing disability.
- File Compliance: Ensure claim files are handled in accordance with applicable statutes, service contracts, and company guidelines.
- Vocational Rehabilitation: Review and approve vocational rehabilitation plans.
- Monetary Reserves: Establish, monitor, and adjust monetary case reserves as warranted and within assigned authority levels.
- Medical Bill Review: Review medical bills for appropriateness prior to referral to InterMed for payment and posting to the claim file.
- Courteous Attitude: Exhibit a courteous and helpful attitude, projecting a professional image on behalf of the company.
- Labor Code Knowledge: Working knowledge of the Labor Code of the State of California pertaining to workers' compensation claims and handling them legally.
- Litigation Management: Direct, manage, and control the litigation process.
- Teamwork: Supports everyone's efforts to succeed.
The estimated salary range for this position is $36.53 - $43.27 per hour.
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