Intercare Holdings Insurance Services

Insurance

• Investigate, analyze, and determine extent of insurer liability for personal, casualty, or property loss and attempt settlements.
• Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information.
• Calculate benefit payments and approve payment of claims within monetary limits.
• Assess and estimate vehicle and property damage; inspect property and gather physical evidence.
• Research property and legal records, examine evidence, and follow contract/property/insurance laws and rules of evidence.
• Review insurance applications and policies to determine coverage and evaluate liability exposure.
• Obtain, review and evaluate records (police, medical, etc.) and recommend claim action; reserve and adjust claim reserves per guidelines.
• Create and maintain records, reports and active diaries in SIMS and/or Renaissance systems; prepare timely client reports.
• Provide litigation management support and keep clients advised; perform other duties as assigned.

General Liability Claims Adjuster II

• 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.

General Liability Claims Adjuster II

Workers Compensation Claims Adjuster III