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Intercare Holdings Insurance ServicesCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing workers' compensation claims, including compliance with California Labor Code, litigation management, and effective communication with claimants and medical professionals. Proficient in evidence gathering, fraud identification, and maintaining action plans for indemnity claims.
Highest-signal resume keywords
Workers' Compensation Claims ManagementCalifornia Labor Code KnowledgeLitigation Management ExperienceFraud Identification and ReferralIndemnity Claims Action Planning
About the role
Key responsibilities & impact- Report directly to the unit Claims Supervisor
- Manage assigned workers’ compensation claim files through conclusion
- Perform three-point contact on all new losses within 24 hours with the claimant, employer, and treating physician
- Gather evidence and document facts related to incidents, disability, treatment, compensability, payments, vendors, and claim status
- Maintain current action plans for assigned indemnity claims
- Partner with the medical case manager to maximize early return-to-work potential
- Refer suspected fraud cases to the SIU
- Pursue subrogation, contributions, and apportionment
- Ensure claim files comply with applicable statutes, service contracts, and company guidelines
- Review and approve vocational rehabilitation plans
- Establish, monitor, and adjust monetary case reserves within authority levels
- Review medical bills before referral to InterMed for payment and claim-file posting
- Respond to telephone and written inquiries within required timeframes
- Direct, manage, and control the litigation process
- Perform other duties assigned by the Supervisor or Manager
- Maintain a courteous, helpful attitude and professional company image
Requirements
What you’ll need- Bachelor’s degree (B.A.) or equivalent from a four-year college; or 3–5 years related experience and training; 5 years without a SIP certificate; or equivalent combination of education and experience
- Working knowledge of the Labor Code of the State of California as it pertains to workers compensation claims and the legal requirements for handling them
- Ability to manage an assigned inventory of claim files to conclusion
- Ability to perform three-point contact with claimant, employer, and treating physician
- Ability to gather and analyze evidence regarding compensability, disability payments, vendors, medical and expense payments, and claim status
- Ability to create and maintain plans of action for assigned indemnity claims
- Ability to partner with medical case managers to support early return to work
- Ability to identify suspected fraud and refer cases to the SIU
- Ability to pursue subrogation, contributions, and apportionment
- Ability to comply with applicable statutes, service contracts, and company guidelines
- Ability to review and approve vocational rehabilitation plans
- Ability to establish, monitor, and adjust monetary case reserves within assigned authority levels
- Ability to review medical bills for appropriateness
- Litigation management experience, including directing, managing, and controlling the litigation process
- Problem-solving, customer service, interpersonal, and teamwork competencies
- Ability to respond to telephone messages and inquiries within 24 hours and written inquiries within one week
- Ability to perform essential duties satisfactorily, with or without reasonable accommodation
Benefits
Comp & perks- Comprehensive medical, dental, and vision benefits
- Company contributions to HSA and FSA plans
- Employer paid life and disability insurance
- 401(k) with company match
- Paid time off (PTO) and company paid holidays
- Learning and development opportunities that support real career advancement
- Employee assistance resources
- Supportive culture that values balance and wellbeing
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims File ManagementEvidence Gathering and AnalysisVocational Rehabilitation Plan ReviewMonetary Case Reserves ManagementSubrogation and Contributions Pursuit
Soft Skills
Problem-SolvingCustomer ServiceInterpersonal SkillsTeamworkProfessional Attitude
Certifications & Qualifications
Bachelor's DegreeSIP Certificate
Industry Keywords
Workers' CompensationFraud InvestigationClaim Status DocumentationReturn-to-Work CoordinationService Contracts Compliance