Compensation Claims Manager III

7 days ago


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

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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