Intercare Holdings Insurance Services

Workers Compensation Claims Adjuster III

Intercare Holdings Insurance Services

full-time

Posted on:

Origin:  • 🇺🇸 United States

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Salary

💰 $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.