Insurance Claims Specialist
1 week ago
At Intercare Holdings Insurance Services, Inc., we are seeking a highly skilled Insurance Claims Specialist to join our team. As a key member of our claims department, you will be responsible for managing an assigned inventory of claim files from start to finish.
Main Responsibilities:
- Conduct thorough investigations into workers compensation claims, gathering relevant evidence and information to establish compensability and determine the need for disability payments.
- Collaborate with medical case managers to develop strategies for maximizing early return-to-work potential and reducing the need for extended disability payments.
- Review and approve vocational rehabilitation plans, ensuring they align with company guidelines and applicable statutes.
- Establish and adjust monetary case reserves as needed, adhering to assigned authority levels.
- Pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre-existing disability.
- Initiate referrals to the Special Investigations Unit (SIU) for cases with suspected fraud.
Requirements:
- Bachelor's degree or equivalent from a four-year college or 3-5 years of related experience and training.
- Working knowledge of the Labor Code of the State of California and legal requirements for handling workers compensation claims.
- Excellent problem-solving, customer service, and interpersonal skills.
- Able to work effectively in a team environment and maintain confidentiality.
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