Intercare Holdings Insurance Services

Claims Specialist

• Reports directly to the unit Claims Supervisor.
• Responsible for effectively managing to conclusion an assigned inventory of claim files.
• Perform a three-point contact on all new losses within 24 hours of receipt of the claim.
• Document relevant facts surrounding the incident itself as well as disability and treatment status.
• Gather evidence regarding ongoing case facts and relevant information necessary for establishing compensability.
• Form a partnership with the medical case manager to maximize early return to work potential.
• Initiate the referral to the SIU of cases with suspected fraud.
• Review and approve all vocational rehabilitation plans.
• Establish, monitor, and adjust monetary case reserves when warranted.

Claims Adjuster II

• Conduct an initial investigation of the claim.
• Verify and enter data into the claims systems.
• Research and gather evidence.
• Obtain, review, and evaluate records, police, medical, etc.
• Correspond with or interview medical specialists, agents, witnesses, or claimants for accuracy and consistency with the claim as reported.
• Investigate, analyze, and determine the extent of the insurance provider's liability concerning personal, casualty, or property loss or damages, and attempt to settle with claimants.
• Comply with accepted guidelines regarding reserving practice and authority levels while properly setting the reserve and adjusting as appropriate.
• Examine, process, calculate, and pay claims ensuring filings, documentation, and reports, etc.
• Prepare timely reports for clients.

General Liability and Auto Claims Processor

• Investigate, analyze, and determine the extent of insurance provider's liability concerning personal, casualty, or property loss or damages.
• Attempt to effect settlement with claimants.
• Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information.
• Calculate benefit payments and approve payment of claims within a certain monetary limit.
• Investigate claims: Assess and estimate vehicle damage.
• Assist with business or managerial research. Compile information through interviews.
• Evaluate customer records. Examine evidence to determine if it will support claims.
• Follow contract, property, or insurance laws.
• Follow rules of evidence procedures in legal setting. Gather physical evidence.
• Inspect property to determine damages. Research property records. Search legal records.
• Maintain all cases on an active diary on the SIMS and/or Renaissance system.
• Prepare timely reports to clients. Comply with all reporting requirements/steps set out in the GHC Procedure Manual. Comply with regulatory requirements.
• Collect evidence to support contested claims in court. Keep clients advised.

General Liability and Auto Claims Adjuster III

Accounting Manager

• Support the Client Accounting Manager with the day-to-day management of the department
• Develop and manage tracking mechanisms for client funding
• Assist with the department’s compliance efforts as they relate to the changing regulatory environment surrounding claim payments and reporting
• Develop and manage client reporting dashboards for internal use
• Assist the Client Accounting Manager and VP of Accounting with the management of client relationships
• Interact with colleagues across departments to communicate the status of payments and compliance efforts

Senior Staff Accountant – Client Accounting

• Adjudicate workers’ compensation claims by means of a timely and thorough investigation to determine compensability
• Frequent communication with all appropriate parties involved with the claim
• Establish timely and appropriate reserves and paid benefits timely, in accordance with Texas Workers’ Compensation Statute.
• Develop and proactively manage claims through well-developed action plans to bring the claim to a timely resolution
• Prepare necessary State filings within statutory limits
• Actively manage the litigation process, ensuring timely and cost-effective claims resolution
• Manage claim recoveries of all types, including but not limited to subrogation, SIF recoveries, and social security, child support and attorney fee offsets
• Coordinate vendor referrals for additional investigation and/or litigation management
• Utilize appropriate cost containment measures to reduce overall claim costs
• Develop professional relationships with your internal and external partners
• Effective communication which is both articulate and tactful
• Eagerness to collaborate with all teams and employees
• Prioritize and organize multiple tasks with great focus and attention to detail. Handles distractions well.

Workers Compensation Claims Adjuster III

• Reports directly to the unit Claims Supervisor.
• Responsible for effectively managing assigned inventory of claim files.
• Perform three-point contact on new losses.
• Gather evidence for establishing compensability and need for payments.
• Partner with medical case manager to maximize early return to work potential.
• Initiate referral to SIU for suspected fraud cases.
• Aggressively pursue subrogation from culpable third parties.
• Assure claims are handled according to statutes and guidelines.
• Review medical bills for appropriateness prior to payment.

Workers Compensation Claims Adjuster II

• Reports directly to the unit Claims Supervisor
• Responsible for effectively managing to conclusion an assigned inventory of claim files
• Perform a three-point contact on all new losses within 24 hours of receipt of the claim
• Thoroughly and accurately document ongoing case facts and relevant information necessary for establishing compensability
• Form a partnership with the medical case manager to maximize early return to work potential
• Initiate the referral to the SIU of cases with suspected fraud
• Aggressively pursue subrogation from culpable third parties