Senior Workers Compensation Claims Specialist

1 week ago


Rocklin, California, United States Intercare Insurance Full time
Job Overview

Position: Claims Adjuster III

Company: Intercare Insurance

Summary: This role reports directly to the Claims Supervisor and may require providing technical support in their absence. The individual will be responsible for managing a portfolio of claims, including those of significant complexity or unique circumstances, in accordance with relevant regulations and company policies.

Key Responsibilities
  • Conduct initial contact with all new claims within 24 hours, engaging with the claimant, employer, and medical provider to gather essential details regarding the incident and ongoing treatment.
  • Accurately document case developments and pertinent information necessary for determining compensability, disability payments, and other related expenses.
  • Ensure that all indemnity claims have a current action plan outlining steps to resolve the claim effectively.
  • Collaborate with medical case managers to facilitate early return-to-work opportunities, minimizing extended disability costs.
  • Refer cases with suspected fraudulent activity to the Special Investigations Unit.
  • Pursue subrogation from liable third parties and manage cases involving multiple defendants.
  • Maintain compliance with applicable laws and company guidelines throughout the claims process.
  • Review and approve vocational rehabilitation strategies.
  • Establish and adjust monetary reserves for cases as necessary, adhering to assigned authority levels.
  • Evaluate medical bills for appropriateness before processing for payment.
  • Exhibit professionalism and a supportive demeanor while representing the company.
  • Respond to inquiries promptly, ensuring effective communication.
  • Possess a comprehensive understanding of the Labor Code as it pertains to workers' compensation claims.
  • Manage litigation processes effectively.
  • Perform additional duties as assigned by the Supervisor or Manager.
Qualifications

To excel in this position, candidates must demonstrate the ability to fulfill each essential duty effectively. The following qualifications are necessary:

  • Bachelor's degree from an accredited institution.
  • A minimum of seven years of relevant experience in claims handling, particularly with indemnity cases.
  • Possession of an SIP certificate is required.
Certifications

Active pursuit of the IEA Certificate and Self-Insured Certificate, along with completion or active study for the WCCP designation or equivalent qualifications.



  • Rocklin, California, United States Intercare Insurance Full time

    Job OverviewPosition: Senior Claims AdjusterCompany: Intercare InsuranceSummary: The Senior Claims Adjuster plays a crucial role in managing a portfolio of complex workers' compensation claims. This position requires a deep understanding of the claims process and the ability to navigate intricate cases effectively.Key ResponsibilitiesConduct thorough...


  • Rocklin, California, United States Intercare Holdings Insurance Services, Inc. Full time

    Job SummaryIntercare Holdings Insurance Services, Inc. is seeking a highly skilled Workers Compensation Claims Adjuster III to join our team. As a key member of our claims department, you will be responsible for effectively managing to conclusion an assigned inventory of claim files that may include cases of extreme complexity or with unique or unusual...


  • Rocklin, California, United States Liberty Mutual Full time

    Job Title: Compensation Claims Management SpecialistCompany: Liberty MutualDescription: As a Compensation Claims Management Specialist at Liberty Mutual, you will be an integral part of a dedicated Claims Team, leveraging advanced technology to oversee a portfolio of routine to moderately intricate claims. Your role will encompass making informed decisions...

  • Claims Specialist

    4 weeks ago


    Rocklin, California, United States Liberty Mutual Insurance Full time

    Description Under limited supervision and established practices, responsible for the investigation, evaluation, and disposition of Complex Workers Compensation cases of high exposure and severity.Has developed high level knowledge of Workers Compensation claims handling techniques, a full knowledge of LMG claims procedures and is cognizant of new industry...


  • Rocklin, California, United States Intercare Insurance Services Full time

    Workers Compensation Claims Supervisor Job Details Job Type Full-time LocationRocklin, CA DescriptionOverview: The Workers Compensation Claims Supervisor plays a pivotal role in overseeing the operations of a claims unit under the guidance of the Claims Manager. This position is essential for ensuring the effective management of claims specialists and...


  • Rocklin, California, United States Intercare Insurance Services Full time

    Workers Compensation Claims Supervisor Job Details Job Type Full-time DescriptionOverview: This position reports directly to the Claims Manager and is tasked with overseeing the performance of a claims unit that includes Claims Specialists managing specific inventories of claims. The unit also encompasses Claims Assistants who provide essential clerical...


  • Rocklin, California, United States Intercare Insurance Full time

    Job OverviewPosition: Claims Adjuster IIICompany: Intercare InsuranceSummary: The Claims Adjuster III is responsible for managing a portfolio of complex claims, ensuring compliance with legal and company standards. This role requires a proactive approach to resolving claims efficiently and effectively.Key ResponsibilitiesConduct thorough investigations on...


  • Rocklin, California, United States Intercare Insurance Services Full time

    Workers Compensation Claims Supervisor Job Details Job Type Full-time DescriptionOverview: This position reports directly to the Claims Manager and is accountable for the overall performance of a claims unit consisting of Claims Specialists responsible for managing designated inventories of claim files. The unit also includes Claims Assistants who provide...


  • Rocklin, California, United States Caltcm Full time

    Custodial Specialist for Senior Living CommunityCompany: CaltcmPosition Type: FULL-TIME (Sunday thru Thursday, 7am to 3pm)At Caltcm, our Custodial Specialist plays a vital role in maintaining a clean and welcoming environment for our residents, their families, and our staff. This position is not just about cleaning; it’s about enhancing the quality of life...


  • Rocklin, California, United States Caltcm Full time

    Custodial Specialist for Senior Living CommunityCompany: CaltcmPosition Type: FULL-TIME (Sunday thru Thursday, 7am to 3pm)At Caltcm, our Custodial Specialist plays a vital role in maintaining a clean and welcoming atmosphere for our residents, their families, and our team members. We take pride in enhancing the quality of life for seniors, ensuring their...


  • Rocklin, California, United States Caltcm Full time

    Custodial Specialist for Senior Living CommunityCompany: CaltcmPosition Type: FULL-TIME (Sunday thru Thursday, 7am to 3pm)At Caltcm, our Custodial Specialist plays a vital role in maintaining a clean and welcoming atmosphere for our residents, their families, and our team members. This position is essential in ensuring that we uphold the highest standards of...


  • Rocklin, California, United States EK Health Services Inc Full time

    Job OverviewAre you passionate about healthcare and interested in transitioning from direct patient care to a more analytical role? This position offers a unique opportunity to leverage your clinical expertise in a non-clinical environment.As a Utilization Review Specialist at EK Health Services Inc, you will be instrumental in evaluating the necessity and...


  • Rocklin, California, United States EK Health Services Full time

    Job TypeFull-timePosition OverviewAre you looking to transition from direct patient care to a more analytical role within the healthcare sector? This opportunity is an excellent pathway to utilize your Nursing or Physical Therapy credentials in a non-clinical environment. If you are passionate about healthcare and enjoy analyzing medical data, this role as a...


  • Rocklin, California, United States Jeld-Wen Inc. Full time

    About the RoleWe are seeking a highly skilled and experienced Senior Environmental Health and Safety Specialist to join our team at Jeld-Wen Inc. As a key member of our organization, you will play a critical role in ensuring the health, safety, and well-being of our employees, customers, and the environment.Key ResponsibilitiesDevelop and implement effective...


  • Rocklin, California, United States Insight Global Full time

    Job OverviewPosition: Customer Service SpecialistLocation: Rocklin, CACompensation: $20.80/hr - $22.24/hr (commission available) Essential Qualifications:1-2 years of experience in customer service within a dynamic environment.At least 1 year of recent experience in sales.Demonstrated success in upselling products or services.Strong computer proficiency (MS...


  • Rocklin, California, United States Insight Global Full time

    Job OverviewWe are seeking dedicated individuals to join our team as Client Support Specialists. This role is essential in providing exceptional service to our clients and ensuring their inquiries are addressed effectively.Key Responsibilities:The Client Support Specialist will:Handle incoming client calls, providing solutions to their questions and...


  • Rocklin, California, United States Iron Oak Plumbing Inc Full time

    Job OverviewWe are a residential plumbing service seeking to fill a part-time position for an Administrative Support Specialist. The successful candidate will be diligent and capable of managing a variety of office-related tasks. This role requires a high level of attention to detail and the ability to maintain confidentiality while exploring innovative...

  • Senior Safety Analyst

    2 weeks ago


    Rocklin, California, United States PG&E Corporation Full time

    Position OverviewThe role focuses on identifying, mitigating, and minimizing safety hazards within operational environments. The individual will leverage their expertise in field assessments to provide recommendations for corrective measures. This position involves collaboration with various business units to address safety concerns and communicate trends,...


  • Rocklin, California, United States PG&E Corporation Full time

    Position OverviewThe role focuses on identifying, mitigating, and minimizing safety hazards within operational environments. This position leverages expertise in on-site evaluations, providing recommendations for corrective measures. It involves collaboration with various business units to address safety concerns and communicate safety patterns while...


  • Rocklin, California, United States PG&E Corporation Full time

    Position OverviewThe role focuses on identifying, mitigating, and minimizing safety hazards within operational environments. The individual will leverage their expertise in on-site evaluations to provide insights on necessary corrective measures. This position involves collaboration with various business units to enhance safety protocols and practices. The...