Senior Medical Case Specialist – Hybrid

Intact Insurance Specialty Solutions

. Provide telephonic medical case management for claims involving disability and medical treatment .

Posted 10/27/2026full-timeUnited StatesSenior💰 $88,000 - $124,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in telephonic medical case management, coordinating care for injured workers while ensuring compliance with regulatory standards and state guidelines. Proficient in advocating for injured employees and facilitating communication among stakeholders in the workers' compensation process.

Highest-signal resume keywords

Registered Nurse (RN) LicensureTelephonic Case Management ExperienceWorkers Compensation KnowledgeUtilization Review Accreditation (URAC) FamiliarityRegulatory Environment Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Case ManagementReturn-To-Work CoordinationBodily Injury Claims ReviewTreatment Plan CoordinationCase Record MaintenanceTelehealth Follow-UpsMedical Treatment EvaluationQuality Improvement InitiativesClaims ReportingPolicy and Contract Understanding

Soft Skills

CommunicationAdvocacyEducationGuidanceCollaboration

Certifications & Qualifications

Registered Nurse (RN) Licensure

Industry Keywords

Workers CompensationUtilization ReviewRegulatory StandardsState GuidelinesInjury Management

About the role

Key responsibilities & impact

Provide telephonic medical case management for claims involving disability and medical treatment
Facilitate communication between employers, injured employees, healthcare providers and claims professionals
Coordinate return-to-work and medical care plans
Assist with in-house medical reviews of bodily injury claims according to applicable state rules, regulations and treatment guidelines
Advocate for, support, educate, guide and coordinate care for injured workers
Coordinate with medical providers to ensure injured employees participate in prescribed treatment plans
Identify appropriate providers and facilities and ensure resources are used timely, cost-effectively and according to state rules and guidelines
Answer injured workers’ questions and address concerns about care and workers’ compensation processes
Maintain accurate, current case records in compliance with company policies and regulatory standards
Prepare and submit case progress and outcome reports to claims adjusters, insureds and management
Monitor progress through regular telehealth follow-ups with employers and injured employees
Develop strategies to facilitate return to work and maximum medical improvement
Evaluate medical treatment requests against jurisdictional guidelines
Participate in quality improvement initiatives
Collaborate with and serve as a resource for claims adjusters across the Claims organization
Apply regulatory and jurisdictional workers compensation knowledge effectively

Requirements

What you’ll need

Current and valid compact licensure as a Registered Nurse (RN) is required
5-7 years of experience in telephonic case management
Two plus 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
Strong professional knowledge of regulatory environments
Workers compensation knowledge in the 46 states in which we operate
Continuing education as required

Benefits

Comp & perks

Bonus potential
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
Flexible work arrangement options
Professional growth, learning and development opportunities