Senior Medical Case Specialist (Hybrid)
About The Position
Intact Insurance Specialty Solutions is seeking a Senior Medical Case Specialist to join its Specialty Recovery Claims team in Denver, Colorado, or Farmington, Connecticut, on a hybrid schedule. The position provides telephonic medical case management, coordinating communications among employers, injured employees, healthcare providers, and claims professionals to support medical care and return-to-work plans for claims involving disability and medical treatment. 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 advocates for injured workers, coordinates care and treatment, evaluates medical requests, monitors recovery, and supports return to work and maximum medical improvement. The role maintains case records and reports, advises claims adjusters, applies workers’ compensation regulatory knowledge, and participates in quality improvement initiatives. The position serves Intact’s U.S. team, operating across 46 states.
Requirements
- Current and valid compact licensure as a Registered Nurse (RN).
- 5–7 years of experience in telephonic case management, including more than 2 years 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, ensuring resources are used in a timely and cost-effective manner and in accordance 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, up-to-date case records in compliance with company policies and regulatory standards.
- Prepare and submit reports on case progress and outcomes to claims adjusters, insureds, and management.
- Monitor claims involving medical treatment and/or disability through regular telehealth follow-ups with employers and injured employees to assess recovery and 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 for compliance with 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 workers’ compensation knowledge for 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 and annual contributions of up to 12% of annual salary.
- Mental health support programs.
- Life and disability insurance.
- Paid parental leave.
- Additional voluntary benefits.
- Bonus potential for full-time employees.
- Flexible work arrangements and time-off options.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
