Senior Medical Case Specialist (Hybrid)
About The Position
Intact Insurance Specialty Solutions is hiring a Senior Medical Case Specialist for its U.S. Specialty Recovery Claims team. The role is based in one of the listed offices—Denver, CO; Raleigh, NC; Alpharetta, GA; Farmington, CT; Morristown, NJ; or Boston or Canton, MA—and follows a hybrid schedule. The specialist provides telephonic medical case management for claims involving disability and medical treatment, coordinating communication among employers, injured employees, healthcare providers, and claims professionals to support care plans and return to work. The role also assists with in-house medical reviews of bodily injury claims in accordance with applicable state rules, regulations, and treatment guidelines. The specialist maintains knowledge of workers’ compensation requirements across the 46 states in which the company operates and participates in continuing education as required.
Requirements
- Current and valid compact licensure as a Registered Nurse (RN).
- 5–7 years of experience in telephonic case management.
- More than two years of experience working with workers’ compensation insurance.
- Familiarity with Utilization Review Accreditation (URAC) standards.
- Experience understanding policies and contracts as they apply to policy conditions.
Responsibilities
- Advocate for injured workers by supporting, educating, guiding, and coordinating their care.
- Coordinate with medical providers to help ensure injured employees participate in prescribed treatment plans.
- Identify appropriate providers and facilities across the continuum of services, and help ensure resources are used in a timely, cost-effective manner consistent with state rules and guidelines.
- Serve as a point of contact for injured workers, answering questions and addressing concerns about care and workers’ compensation processes.
- Facilitate clear communication among insureds, providers, injured workers, and claims adjusters.
- Maintain accurate and up-to-date case records in compliance with company policies and regulatory standards.
- Prepare and submit case progress and outcome reports to claims adjusters, insureds, and management.
- Conduct regular telehealth follow-ups with employers and injured employees on claims involving medical treatment and/or disability to monitor progress and help facilitate return-to-work plans.
- Develop strategies to help client employees return to work and reach maximum medical improvement as soon as they are able.
- Evaluate medical treatment requests to ensure they meet jurisdictional guidelines.
- Participate in quality improvement initiatives to enhance service delivery and patient outcomes as needed.
- Collaborate with and serve as a resource for claims adjusters across the Claims organization.
- Maintain professional knowledge of regulatory environments and apply it effectively.
- Acquire and maintain knowledge of workers’ compensation requirements in the 46 states in which the company operates, and participate in continuing education as required.
- Assist with in-house medical reviews of bodily injury claims in accordance with applicable state rules, regulations, and treatment guidelines.
Benefits
- Comprehensive medical, dental, and vision insurance with no waiting period.
- Competitive paid time off programs.
- 401(k) savings plan and annual contributions of up to 12% of annual salary.
- Bonus potential for full-time employees.
- Mental health support programs.
- Life and disability insurance.
- Paid parental leave.
- Additional voluntary benefits.
- Time-off and flexible work arrangement options.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
