Intercare Holdings Insurance Services-posted about 1 year ago
$70,000 - $92,000/Yr
Full-time • Senior
Fresno, CA

The Workers Compensation Claims Adjuster III is responsible for managing a complex inventory of claim files, ensuring compliance with applicable statutes and company guidelines. This senior-level position reports to the Claims Supervisor and may provide technical support in their absence. The role involves thorough documentation, collaboration with medical case managers, and proactive management of claims to facilitate timely resolutions and minimize costs.

  • Perform a three-point contact on all new losses within 24 hours of receipt of the claim, including the claimant, employer, and treating physician.
  • Document ongoing case facts and relevant information necessary for establishing compensability and the need for disability payments.
  • Assure that all assigned indemnity claims have an up-to-date plan of action for resolution.
  • Form a partnership with the medical case manager to maximize early return to work potential.
  • Initiate referrals to the SIU for cases with suspected fraud.
  • Pursue subrogation from culpable third parties and manage contributions on multiple defendant cases.
  • Ensure compliance with applicable statutes and company guidelines in handling claim files.
  • Review and approve all vocational rehabilitation plans.
  • Establish, monitor, and adjust monetary case reserves as warranted.
  • Review medical bills for appropriateness prior to payment and posting to the claim file.
  • Maintain a courteous and professional image on behalf of the company.
  • Respond to telephone messages and inquiries within 24 hours and to written inquiries within one week.
  • Bachelor's degree (B.A.) from a four-year college or university.
  • At least seven years of related experience and/or training, or equivalent combination of education and experience.
  • Minimum of five years experience managing indemnity cases, including complex or high potential subrogation, rehabilitation, medical management, and/or legal issues.
  • Possess an SIP certificate.
  • Experience with litigation management.
  • Knowledge of the Labor Code of the State of California as it pertains to workers compensation claims.
  • Full-time position with a salary range of $70,000 - $92,000 per year.
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