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Workers Compensation Claims Specialist
2 months ago
**Job Summary:**
As a Workers Compensation Claims Specialist at Intercare Insurance, you will play a critical role in managing and resolving workers' compensation claims in a timely and efficient manner. This position requires a high degree of claims handling expertise, including experience in managing indemnity cases with complex or high potential subrogation, rehabilitation, medical management, and/or legal issues.
Key Responsibilities:
- Claims Management: Effectively manage an assigned inventory of claim files, including cases of extreme complexity or with unique or unusual issues.
- Communication: Perform a three-point contact on all new losses within 24 hours of receipt of the claim to include the claimant, employer, and treating physician to document relevant facts surrounding the incident itself as well as disability and treatment status.
- Documentation: Thoroughly and accurately document ongoing case facts and relevant information necessary for establishing compensability, the need for disability payments, the use of vendors, medical and expense payments, and what is being done to move the case toward closure.
- Partnership Building: Form a partnership with the medical case manager to maximize early return to work potential thereby reducing the need for extended disability payments, vocational rehabilitation, and other protracted claims costs.
- Fraud Detection: Initiate the referral to the Special Investigations Unit (SIU) of cases with suspected fraud.
- Subrogation: Aggressively pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre-existing disability.
- Compliance: Assure that the claim file is handled totally in accordance with applicable statutes as well as in-force service contracts and company guidelines.
- Vocational Rehabilitation: Review and approve all vocational rehabilitation plans.
- Reserve Management: Establish, monitor, and adjust monetary case reserves when warranted and in strict accordance with assigned authority levels.
- Medical Bill Review: Review all medical bills for appropriateness prior to referral to InterMed for payment and posting to the claim file.
- Professional Image: Exhibit and maintain a courteous and helpful attitude and project a professional image on behalf of the company.
- Customer Service: Respond to telephone messages and inquiries within 24 hours of receipt and to written inquiries within one week of receipt.
- Knowledge and Skills: Requires a working knowledge of the Labor Code of the State of California as it pertains to workers compensation claims and the legal requirements for handling them.
- Litigation Management: Direct, manage, and control the litigation process.
Requirements:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience:
Bachelor's degree (B. A.) from four-year college or university; at least seven years related experience and/or training; or equivalent combination of education and experience. Requires a high degree of claims handling expertise to include a minimum of at least five years experience managing indemnity cases, many with complex or high potential subrogation, rehabilitation, medical management, and/or legal issues & possess an SIP certificate.
