Compensation Claims Manager III
7 days ago
Job Summary:
As a Compensation Claims Manager III at Intercare Holdings Insurance Services, Inc., you will play a crucial role in managing an assigned inventory of claim files, ensuring effective resolution and minimizing costs. With a focus on exceptional customer service, you will provide technical backup to the unit Claims Supervisor as needed.
Key Responsibilities:
- Perform thorough three-point contact with claimants, employers, and treating physicians within 24 hours of receiving new losses.
- Accurately document case facts and relevant information to establish compensability, disability payments, vendor usage, medical expenses, and plan of action for resolving claims.
- Develop and maintain up-to-date plans of action for assigned indemnity claims, outlining activities and actions to resolve cases efficiently.
- Collaborate with medical case managers to maximize early return to work potential, reducing extended disability payments and protracted claims costs.
- Identify and refer cases with suspected fraud to the Special Investigation Unit (SIU).
- Pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when pre-existing disabilities are present.
- E nsure compliance with applicable statutes, service contracts, and company guidelines in handling claim files.
- Review and approve vocational rehabilitation plans.
- Establish, monitor, and adjust monetary case reserves according to assigned authority levels.
- Verify medical bills for appropriateness before referring them to InterMed for payment and posting to the claim file.
- Maintain a professional image and courteous attitude, responding to inquiries and messages promptly.
- Stay updated on Labor Code requirements for workers' compensation claims and legal handling procedures.
- Litigation management: Direct, manage, and control the litigation process.
Requirements:
- Problem-solving skills to identify and resolve issues timely.
- Customer service expertise to handle difficult situations and meet commitments.
- Interpersonal skills to maintain confidentiality, listen actively, and remain open to others' ideas.
- Teamwork support to ensure everyone's success.
Qualifications:
- Bachelor's degree from a four-year college or university.
- At least seven years related experience and/or training, or equivalent combination of education and experience.
- A high degree of claims handling expertise, including five years of experience managing indemnity cases with complex or high-potential subrogation, rehabilitation, medical management, and/or legal issues.
- An active SIP certificate is required.
Compensation:
The estimated salary for this position ranges from $45.00 to $52.00 per hour, based on industry standards and location factors.
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