Claims Adjuster

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🔥 1 minute ago

🏄 California – Remote

🏄 California – Remote

💵 $110k / year

⏰ Full Time

🟠 Senior

🔴 Lead

📋 Claims Specialist

👻 Ghost score 1%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Just posted.
• Jobs at this company usually fill in 21 days.

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Intercare Holdings Insurance Services

WebsiteLinkedInAll Job Openings

201 - 500 employees

🛡️ Insurance

Insurance • Risk Management

Intercare Holdings Insurance Services is a privately held company that specializes in workers' compensation and liability claims administration, managed care services, and risk management solutions. Known for their client care and responsive service, Intercare integrates advanced technology and has an in-house Special Investigations Unit (SIU) to handle claims efficiently and reduce fraudulent activities. Their unique approach combines the depth and capacity of a large organization with the flexibility of a smaller firm, ensuring customized risk management and cost control solutions for clients. With a strong emphasis on customer satisfaction, Intercare is a trusted partner in reducing risk and maintaining fiscal stability for their clients.

📋 Description

• Manage all aspects of workers compensation claims throughout the claim lifespan • Determine compensability and verify coverage • Administer disability and medical benefits • Negotiate claim resolutions and assist injured employees, employers, and medical/legal professionals • Receive newly reported claims and maintain updated claim notes • Record claim information in an electronic database • Interview claimants, insureds, medical professionals, and witnesses to determine claim validity • Communicate claim compensability decisions to claimants, employers, and medical providers • Set appropriate reserves based on the nature and extent of injuries • Calculate lost-time wages, make disability payments, and diary future payments • Order independent medical examinations and prepare documentation for physician review • Correspond regularly with claimants, insureds, and nurse case managers regarding claim updates, appointments, and disability-payment issues • Review and process medical bills through a third-party vendor for discount opportunities • Collaborate with claimants and insureds to pursue early return-to-work • Partner with legal counsel on litigated claims and provide documentation for defense and exposure evaluation • Attend settlement conferences, mediations, and hearings on behalf of the insurance company or insured • Review and approve defense attorney bills within authority • Work with underwriting on loss information for renewal rates and with Risk Management to identify trends • Interact with insureds' agents regarding losses as needed • Respond to state requests for health-cost disputes, hearing applications, and penalty assessment letters • Identify subrogation potential and pursue recovery • Lead claim reviews with clients as requested • Perform other duties as assigned

🎯 Requirements

• 10 years of experience adjusting Workers Compensation Claims in California required • SIP Certification required • Bilingual (Spanish/English) required • Must be current with CEU's • Proficiency in entire Microsoft Office suite • Knowledge of relevant workers compensation laws • Strong grasp of medical terminology • Familiarity with medical cases and how treatment typically progresses • Excellent oral and written communication abilities • Attention to detail and good organization skills • Ability to negotiate issues and settlements • Strong focus on customer service, including timely response to requests/inquiries • Ability to adapt to changing technologies and learn functionality of new equipment and systems • Ability to establish and maintain effective working relationships with others

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