Intercare Holdings Insurance Services

Supervisor

• Report directly to the Claims Manager
• Oversee the overall work product of a claims unit consisting of Claims Specialists and Claims Assistants
• Coach, counsel, mentor, and provide performance feedback to personnel
• Monitor work performance for compliance with company standards and Labor Code rules and regulations
• Conduct timely performance reviews for all personnel within the assigned unit
• Provide monetary approval authority up to the assigned authority level
• Maintain selected files on personal diary, including files reserved over $50,000, subrogation files, delayed or denied benefit files, SIU files, and files with unresolved coverage issues
• Provide clients with requested information, reports, records, logs, and other materials
• Ensure claims are handled in accordance with applicable statutes and company rules
• Address personnel issues and keep the Claims Manager informed about corrective action
• Identify and develop at least one individual as supervisor backup
• Perform quarterly audits of 10% of each Claims Specialist's open inventory
• Identify opportunities to improve claims-management processes and claim outcomes
• Promote teamwork and cooperation between claims personnel and other departments
• Perform other duties assigned by the Claims Manager

Workers' Compensation Claims Supervisor

Manager

• Manage a claims department comprised of claims supervisors, claims specialists, claims assistants, and other claims personnel
• Report directly to the Vice President of Claims
• Oversee the quantity and quality of the claims department's work product
• Coach, counsel, mentor, and provide performance feedback to claims supervisors and department staff
• Monitor department work product for compliance with Labor Code provisions and company rules and regulations
• Conduct performance evaluations and institute corrective action when appropriate
• Provide monetary approval authority up to the assigned authority level
• Work with client representatives to ensure contractual provisions are followed and client/customer issues are addressed promptly
• Assist supervisors with customer and personnel issues and keep the Vice President of Claims informed about corrective actions
• Identify and develop at least one supervisor as claim manager backup
• Represent the company at industry functions when needed
• Develop and sustain teamwork and cooperation among claims personnel and other departments
• Monitor productivity and compliance trends and implement procedural adjustments to improve productivity and results
• Manage department operating expenses within the approved budget
• Handle other duties assigned by the Vice President of Claims
• Manage 3 to 7 subordinate supervisors overseeing 7 to 10 employees and directly supervise one non-supervisory employee

Workers Compensation Claims Manager

• Report directly to the Claims Manager
• Oversee the overall work product of a claims unit comprising Claims Specialists and Claims Assistants
• Coach, counsel, mentor, and provide performance feedback to unit personnel
• Monitor work performance for compliance with company standards and Labor Code rules and regulations
• Conduct timely performance reviews for all personnel in the assigned unit
• Exercise monetary approval authority up to the assigned authority level
• Maintain selected files on personal diary, including files reserved over $50,000, subrogation files, delayed or denied benefits files, SIU-assigned files, and files with unresolved coverage issues
• Provide clients with requested information, reports, records, logs, and other documentation
• Address personnel issues and keep the Claims Manager informed about corrective action
• Identify and develop at least one individual as supervisor backup
• Perform quarterly audits of 10% of each Claims Specialist's open inventory
• Improve claims management processes and claim results
• Promote teamwork and cooperation across claims personnel and other departments
• Perform other duties assigned by the Claims Manager

Claims Specialist

• Independently manage a complex inventory of indemnity claims from intake through resolution
• Perform three-point contact within 24 hours on all new losses
• Gather and analyze case facts, assess compensability, and maintain current plans of action
• Identify and refer fraud indicators to the SIU
• Handle claims in accordance with applicable statutes, service contracts, and company guidelines
• Direct medical care throughout the claim lifecycle, including treatment authorization, medical control, UR and IME direction, and VR plan review
• Partner with case managers to maximize early return-to-work
• Identify and rate permanent disability in accordance with applicable state guidelines
• Establish, monitor, and adjust case reserves within assigned authority levels
• Prepare accurate and strategically clear 90-day carrier status reports
• Direct defense counsel, set litigation strategy, manage legal budgets, and drive litigated files toward efficient resolution
• Attend mediations and settlement conferences and make settlement authority decisions
• Negotiate and finalize claim settlements, including lien resolution
• Pursue subrogation, multi-defendant contributions, and apportionment on pre-existing disability cases
• Respond to inquiries within required timeframes
• Maintain proactive communication with injured workers, employers, carriers, counsel, and vendors

Worker's Compensation Claims Adjuster II

• Investigate complex, catastrophic, and high-exposure workers’ compensation claims
• Perform three-point contact on all new losses and maintain detailed action plans with strategic resolution planning
• Identify fraud indicators and refer cases to SIU
• Gather and document facts on claims involving multi-party liability, catastrophic injury, significant subrogation potential, or novel legal issues
• Lead medical management, direct specialists, coordinate life care planners, direct UR and IMEs, and manage PTD cases
• Partner with case managers to maximize early return to work and review high-cost or unusual medical treatment
• Lead permanent disability ratings on complex cases
• Establish and adjust reserves on high-exposure files with documented justification
• Ensure status reports comply with client reporting timelines and formats
• Direct litigation, including selecting defense counsel, setting strategy, retaining experts, managing legal spend, and preparing for trial
• Lead mediations, settlement conferences, and arbitrations
• Make or recommend high-value settlement authority decisions with the Claims Supervisor and client
• Negotiate and finalize high-value settlements, including C&R and Stipulated Awards
• Manage multi-lien resolution and coordinate with lien counsel and CMS
• Pursue subrogation, multi-defendant contribution, and apportionment recovery
• Coordinate with recovery vendors and outside subrogation counsel
• Provide technical backup for the Claims Supervisor and guidance on complex decisions, reserve adequacy, and escalated client issues
• Mentor Adjuster I and II colleagues and support unit-wide quality review
• Serve as a senior contact for key client accounts and maintain client and carrier relationships
• Maintain proactive, transparent communication and respond within required timeframes

Worker's Compensation Claims Adjuster III

• Triage all assigned claims within 24 hours of assignment
• Complete initial contacts with the employee, employer, and Primary Care Physician and document referrals within 72 hours when applicable
• Initiate disability management when needed to identify anticipated lost time and coordinate return-to-work processes
• Address medical issues for assigned claims and coordinate timely, appropriate, cost-effective medical care
• Review treatment referrals for medical appropriateness using evidence-based guidelines, best practices, and state-specific rules
• Identify medical diagnoses and treatment plans and validate corresponding care algorithms
• Review treatment protocols and make recommendations using MTUS, ACOEM, MCG, ODG, state-specific treatment guidelines, and provider documentation
• Evaluate over-utilization and negotiate with providers to amend or withdraw treatment requests when appropriate
• Refer potential non-certified cases to peer clinical reviewers
• Perform utilization review on concurrent requests and arrange peer-to-peer contact as needed
• Assist with notification of physician-reviewer non-certifications
• Direct and maximize PPO/MPN network utilization
• Pre-authorize appropriate inpatient and outpatient procedures
• Communicate utilization-review determinations to claims examiners, providers, attorneys, and auxiliary providers within prescribed time frames, followed in writing within 24 hours
• Summarize medical records and pertinent information for Physician Advisors and prepare questions for peer or third-party review
• Work closely with clients, claims handlers, nurse case managers, and supervisors, taking direction when needed
• Direct non-clinical tasks to non-clinical staff when required
• Perform California utilization review in compliance with the Labor Code and California Code of Regulations
• Follow applicable state rules and regulations for utilization review
• Participate in quality-management meetings and projects for at least 5% of average hours worked
• Oversee non-clinician tasks and support non-clinical administrative staff during initial screening
• Monitor potential compromises to patient safety and refer them to the proper authority
• Communicate in plain language with injured workers, claims examiners, and clients

RN, Nurse Case Manager/UR Nurse

• Perform three-point contact on all new losses
• Apply heightened scrutiny to complex, catastrophic, and high-exposure cases
• Maintain detailed action plans and strategic resolution plans for assigned indemnity files
• Identify fraud indicators and refer cases to SIU
• Investigate and document complex claims involving multi-party liability, catastrophic injury, subrogation, or novel legal issues
• Lead medical management, direct specialists, coordinate life care planners, direct UR and IMEs, and manage PTD cases
• Partner with case managers to maximize early return to work
• Review medical bills for high-cost and unusual treatment patterns
• Lead permanent disability ratings and establish or adjust reserves on high-exposure files
• Ensure status reports comply with client reporting timelines and formats
• Direct litigation, select defense counsel, set strategy, retain experts, manage legal spend, and prepare for trial
• Lead mediations, settlement conferences, and arbitrations
• Make or recommend high-value settlement authority decisions with the Claims Supervisor and client
• Negotiate and finalize high-value settlements, including C&R and Stipulated Awards
• Manage multi-lien resolution and coordinate with lien counsel and CMS
• Pursue subrogation, contribution, and apportionment recovery
• Serve as technical backup for the Claims Supervisor
• Guide complex decisions, reserve adequacy, and escalated client issues
• Mentor Adjuster I and II colleagues and support unit-wide quality review
• Serve as senior point of contact for key client accounts
• Maintain client and carrier relationships
• Communicate proactively and transparently with stakeholders

Claims Adjuster III

Recruitment

• Schedule and coordinate interviews between candidates, recruiters, and hiring managers across multiple time zones and calendars
• Serve as candidates' first point of contact and send timely, professional communication throughout the hiring process
• Maintain accurate, up-to-date candidate and requisition records in Paylocity
• Post job openings, track applicant flow, and keep requisition status current
• Complete JCNs and Status Change Forms accurately and on time
• Conduct background checks and follow up on results during the pre-employment process
• Prepare offer letters and new hire paperwork alongside the recruiting team
• Support onboarding logistics
• Assist with sourcing outreach and resume review as time and skill allow
• Handle general administrative tasks for the People Operations department as needed

Recruiting Coordinator

• Investigate and process auto, bodily injury, property damage, and general liability claims
• Consult police and hospital records, examine photographs and statements, and take recorded statements as needed to render a sound liability position
• Evaluate and review bodily injury demands and negotiate claims to settlement
• Evaluate and calculate automobile total loss settlements and diminishment of value claims
• Evaluate and calculate non-vehicle property damage, including supporting documentation
• Negotiate and finalize claim settlements, including lien resolution, in alignment with client authority
• Maintain records, reports, diaries, and files in the CMIS according to company and regulatory criteria
• Document spoken and written case activity in the CMIS and prepare timely status reports for clients
• Respond to inquiries within required timeframes
• Maintain proactive communication with injured workers, employers, carriers, counsel, and vendors throughout each claim

General Liability Claims Adjuster II

• Investigate, analyze, and determine the extent of the insurance provider's liability concerning personal, casualty, auto, or property loss or damages
• Attempt to settle claims with claimants
• Correspond with or interview medical specialists, agents, witnesses, and claimants to compile information
• Calculate and approve payment of claims within a specified monetary limit
• Assess and estimate vehicle or property damage
• Evaluate customer records and examine evidence to determine whether it supports claims
• Follow contract, property, and insurance laws and rules of evidence procedures in legal settings
• Gather physical evidence, inspect property, research property records, and conduct court and legal-record searches
• Obtain, review, and evaluate police, medical, and other records
• Recommend claim action and properly establish and adjust reserves in accordance with guidelines and authority levels
• Maintain records, reports, files, and active claim diaries in the claims system
• Assist in preparing timely reports to clients
• Comply with claims-handling best practices and regulatory requirements
• Collect evidence to support contested claims in court
• Keep clients advised
• Investigate, evaluate, and adjust low- to medium-exposure first- and third-party automobile bodily injury and property damage, premises liability, and product liability claims

Workers' Compensation Claims Supervisor

Workers Compensation Claims Manager

Workers' Compensation Claims Supervisor

Worker's Compensation Claims Adjuster II

Worker's Compensation Claims Adjuster III

RN, Nurse Case Manager/UR Nurse

Claims Adjuster III

Recruiting Coordinator

General Liability Claims Adjuster II

General Liability Claims Representative