Intercare Holdings Insurance Services is hiring a
Workers Compensation Adjuster in Worldwide

Summary

The job is for a Claims Adjuster III in Glendale, CA. The employee will manage an assigned inventory of claim files, perform three-point contact on all new losses within 24 hours, document ongoing case facts, form partnership with medical case manager, initiate referral to SIU of cases with suspected fraud, pursue subrogation, assure compliance with applicable statutes and service contracts, review and approve vocational rehabilitation plans, establish, monitor, and adjust monetary case reserves, review all medical bills, exhibit a courteous attitude, and respond to inquiries within specified timeframes. The candidate must have a Bachelor's degree or equivalent combination of education and experience, at least seven years related experience, an active study for the IEA Certificate and Self-Insured Certificate, and/or the WCCP designation.

Requirements

• Requires a working knowledge of the Labor Code of the State of California as it pertains to workers compensation claims and the legal requirements for handling them
• 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
• At least five years experience managing indemnity cases, many with complex or high potential subrogation, rehabilitation, medical management, and/or legal issues & possess an SIP certificate
• Active study for the IEA Certificate and Self-Insured Certificate, and successful completion of, or active study for the WCCP designation, or the equivalent in related studies or work experience

Responsibilities

• 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, the need for disability payments, the use of vendors, medical and expense payments, and what is being done to move the case toward closure
• Assure that all assigned indemnity claims have an up to date plan of action outlining activities and actions anticipated for ultimately resolving the claim
• Form a partnership with the medical case manager to maximize early return to work potential thereby reducing the need for extended disability payments, vocational rehabilitation, and other protracted claims costs
• Initiate the referral to the SIU of cases with suspected fraud
• Aggressively pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre-existing disability
• Assure that the claim file is handled totally in accordance with applicable statutes as well as in-force service contracts and company guidelines
• Review and approve all vocational rehabilitation plans
• Establish, monitor, and adjust monetary case reserves when warranted and in strict accordance with assigned authority levels
• Review all medical bills for appropriateness prior to referral to InterMed for payment and posting to the claim file
• Exhibit and maintain a courteous and helpful attitude and project a professional image on behalf of the company
• Respond to telephone messages and inquiries within 24 hours of receipt and to written inquiries within one week of receipt