Insurance Verification Representative
Huron
Workers Compensation Claims Adjuster III
Intercare Holdings Insurance Services
full-time
Posted on:
Location: 🇺🇸 United States
Visit company websiteSalary
💰 $85,000 - $100,000 per year
Job Level
SeniorLead
About the role
- Reports directly to the unit Claims Supervisor and may provide technical backup in the absence of the Claims Supervisor.
- Manages an assigned inventory of claim files to conclusion, including cases of extreme complexity or unique/unusual issues, per statutes and company guidelines.
- Conducts a three-point contact within 24 hours of new losses (claimant, employer, treating physician) to document incident facts, disability and treatment status.
- Documents ongoing case facts and information for establishing compensability, disability payments, vendor use, medical/expense payments, and progress toward closure.
- Maintains up-to-date indemnity claim plans of action outlining activities for resolution.
- Partners with medical case manager to maximize early return-to-work, reducing extended disability and costs.
- Initiates referral to SIU for suspected fraud.
- Pursues subrogation, contributions on multiple-defendant cases, and apportionment where pre-existing disability exists.
- Ensures claim file handling complies with statutes, service contracts, and company guidelines.
- Reviews and approves vocational rehabilitation plans.
- Establishes, monitors, and adjusts reserves within authority.
- Reviews medical bills for appropriateness before referral to InterMed for payment.
- Maintains courteous, professional demeanor with timely responses to inquiries.
- Requires knowledge of California Labor Code and litigation management; may handle other duties as assigned.
Requirements
- 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.
- SIP certificate.
- Working knowledge of the California Labor Code as it pertains to workers\' compensation claims.
- Minimum five years of experience managing indemnity cases, including complex or high-potential subrogation, rehabilitation, medical management, and/or legal issues.
- Requires ability to perform each essential duty satisfactorily.
