Claims Adjuster II

5 days ago


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

Intercare Holdings Insurance Services, Inc. is seeking a highly skilled and experienced Claims Adjuster II - Temp to join our team. As a key member of our claims department, you will be responsible for effectively managing to conclusion an assigned inventory of claim files in accordance with applicable statutes and company rules.

Key Responsibilities
  • Claims Management: 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.
  • Evidence Gathering: Thoroughly and accurately gather evidence regarding ongoing case facts and relevant information necessary for establishing compensability, disability payments, and claim resolution.
  • Indemnity Claims: Ensure that all assigned indemnity claims have an up-to-date plan of action outlining activities and actions anticipated for ultimately resolving the claim.
  • Medical Case Management: Form a partnership with the medical case manager to maximize early return to work potential, reducing the need for extended disability payments 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.
  • Claim File Management: Ensure that the claim file is handled in accordance with applicable statutes, service contracts, and company guidelines.
  • Vocational Rehabilitation: Review and approve all vocational rehabilitation plans.
  • Monetary Case Reserves: 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.
  • Customer Service: Exhibit a courteous and helpful attitude, projecting a professional image on behalf of the company.
  • Communication: Respond to telephone messages and inquiries within 24 hours of receipt and to written inquiries within one week of receipt.
Requirements
  • Problem Solving: Identifies and resolves problems in a timely manner, gathers and analyzes information skillfully, develops alternative solutions, and 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, and meets commitments.
  • Interpersonal Skills: Focuses on solving conflict, not blaming, maintains confidentiality, listens to others without interrupting, keeps emotions under control, and remains open to others' ideas and tries new things.
  • Teamwork: 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.) or equivalent from four-year college or; or 3-5 years related experience & training, 5 years without a SIP certificate, or equivalent combination of education and experience.

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