Workers Compensation Claims Specialist

2 weeks ago

Glendale, California, United States Intercare Insurance Full time
Job Title: Workers Compensation Adjuster III

At Intercare Insurance, we are seeking a highly skilled Workers Compensation Adjuster III to join our team. As a key member of our claims department, you will be responsible for managing an assigned inventory of claim files, including cases of extreme complexity or with unique or unusual issues.

Key Responsibilities:
  • Perform a three-point contact on all new losses within 24 hours of receipt of the claim to document relevant facts surrounding the incident, disability, and treatment status.
  • Thoroughly document ongoing case facts and relevant information necessary for establishing compensability, disability payments, vendor use, medical and expense payments, and case resolution.
  • Ensure all assigned indemnity claims have an up-to-date plan of action outlining activities and actions anticipated for resolving the claim.
  • Partner with the medical case manager to maximize early return to work potential, reducing the need for extended disability payments, vocational rehabilitation, and other protracted claims costs.
  • Initiate referrals to the Special Investigations Unit (SIU) for cases with suspected fraud.
  • Pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre-existing disability.
  • Ensure claim files are handled in accordance with applicable statutes, service contracts, and company guidelines.
  • Review and approve vocational rehabilitation plans.
  • Establish, monitor, and adjust monetary case reserves when warranted and in accordance with assigned authority levels.
  • Review medical bills for appropriateness prior to referral to InterMed for payment and posting to the claim file.
  • Exhibit a courteous and helpful attitude, projecting a professional image on behalf of the company.
  • Respond to telephone messages and inquiries within 24 hours of receipt and to written inquiries within one week of receipt.
Requirements:

To perform this job successfully, an individual should demonstrate the following competencies:

  • Problem Solving - Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions; uses reason even when dealing with emotional topics.
  • Customer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; responds to requests for service and assistance; meets commitments.
  • Interpersonal - Focuses on solving conflict, not blaming; maintains confidentiality; listens to others without interrupting; keeps emotions under control; remains open to others' ideas and tries new things.
  • Team Work - Supports everyone's efforts to succeed.

Qualification 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.

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