Senior Medical Case Specialist (Hybrid)

Job Description

Job Description

Our employees are at the heart of what we do: helping people, businesses and society prosper in good times and be resilient in bad times. When you join our team, you are bringing this purpose to life alongside a passionate community.

Feel empowered to learn and grow while being valued for who you are. At Intact, we commit to supporting you in reaching your goals with tools, opportunities, and flexibility. It’s our promise to you. 

Who we are

At Intact Insurance Specialty Solutions, we are experts at what we do in protecting what makes businesses unique. Our deep understanding of the specialty insurance market is the foundation for our customized solutions, backed by targeted risk control and claims services. Our employees are passionate about providing insurance coverage that’s aligned to our targeted customer groups.

Intact’s Global Specialty Lines business spans across more than 20 verticals in four distinct markets: U.S., Canada, UK and Europe. The following opportunity is for our U.S. team.

The opportunity

We currently have an opportunity for a Senior Medical Case Specialist to join our Specialty Recovery Claims team based in our Denver, CO, Raleigh, NC, Alpharetta,GA Farmington, CT, Morristown, NJ, Boston or Canton, MA offices on a hybrid schedule. As a Senior Medical Case Specialist you will be part of a top-performing team within Intact Insurance. You will be responsible for providing telephonic medical case management which includes facilitating communications between employers, injured employees, healthcare providers and claims professionals to coordinate return to work and medical care plans on claims involving disability and medical treatment. You’ll also assist with in house medical reviews of bodily injury claims in accordance with any applicable state rules, regulations or treatment guidelines. Some of the Senior Medical Case Specialist responsibilities include but are not limited to:

• Serve as an advocate to support, educate, guide and coordinate care for injured workers.
• Coordinate with medical providers to assure injured employees are participating in a prescribed treatment plan.
• Identify appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner and in accordance with State rules and guidelines to obtain optimum value for both the customer and the reimbursement source.
• Serve as a point of contact for injured workers, answering questions and addressing concerns related to their care and workers' compensation processes.
• Facilitate clear communication between all parties involved in the case, including insureds, providers, injured workers, and claims adjusters.
• Maintain accurate and 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 progress through regular telehealth follow-ups with employers and and injured employees on claims involving medical treatment and/or disability to assess recovery and help facilitate a return-to-work plan.
• Develop strategies that will help our client’s employees return to work and maximum medical improvement as soon as they are able.
• Evaluate medical treatment requests to ensure they meet jurisdictional guidelines.
• Participate in quality improvement initiatives to enhance service delivery and patient outcomes as needed. 
• Collaborates with and is a resource for claim adjusters across the Claims organization.
• Maintains a strong professional knowledge of regulatory environments and applies this information effectively. 
• Acquires and stays abreast of jurisdictional workers compensation knowledge in the 46 states in which we operate and participates in continuing education as required.

The expertise you bring

• Current and valid compact licensure as a Registered Nurse (RN) is required.
• 5-7 years of experience in telephonic case management, with 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.

   

Our salary ranges are determined by many factors including location, role, experience and skillset of the candidate. The following ranges displayed reflect the target base salary for new hires; however, your recruiter will provide more specific compensation details during the hiring process. The typical base salary range for this position is: $88,000 – $124,000, based on the factors aforementioned. For candidates located in San Francisco, CA; Washington DC; our Massachusetts based offices and the New York City metro area, the base salary range is $110,000 - $130,000. In addition to base salary, full time Intact employees are also eligible for bonus potential and a full range of benefits to include but not limited to:

• 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 and a variety of additional voluntary benefits

This position will remain posted until a final candidate is selected. Once the role is filled, this job posting will be removed.    

Why choose Intact

We live our Values:  We are committed to acting with the highest of ethical standards through our five core values: integrity, respect, customer driven, excellence and social responsibility.

Our commitment to Diversity: Founded in our values, we see diversity as a strength and aspire to create an environment where everyone can be themselves, grow and succeed. Together, we will stand up for what’s right to build an inclusive society.

Manage your Time: What you accomplish matters more than hours in the office. We are committed to creating a positive and supportive environment in which you perform your best. Our Time-Off and Flexible Work Arrangement options help foster a healthy work-life balance. 

Check out our Glassdoor reviews to see why people love working for Intact!

Our promise to you

Our Values are foundational to our success at Intact. You’ll make a difference every day when you live our Values, do your best work, are open to change, and invest in yourself.

In return, we promise you support, opportunities and performance-led financial rewards in a flexible work environment where you can:

• Shape the future: Help us lead an insurance transformation to better protect people, businesses and society.
• Win as a team: Collaborate with inspiring people to do your best work every day and together, stand up for what is right.
• Grow with us: Refresh and reinvent your skills, learn from our diverse teams, lift others up, and grow.

About Intact 

At Intact Insurance Specialty Solutions we are experts at what we do. Our deep understanding of the specialty insurance market is the foundation for our customized solutions, backed by targeted risk control and claims services. Our employees are passionate about providing insurance coverage that’s aligned to our targeted customer groups. Today, we help protect over a dozen industries with tailored coverages and services.

#LI-US

#LI-CC1

#LI-HYBRID