Intercare Holdings Insurance Services

• Review medical records to determine the medical necessity of a request for medical services. • Validate diagnosis and corresponding algorithms of care. • Evaluate for over-utilization of treatment requests inconsistent with evidence based guidelines. • Communicate with the claims examiner, providers, and any other auxiliary provider regarding UR determination. • Summarize medical records and all pertinent information for Physician Advisor. • Identify the need for medical case management and make recommendations for referral through supervisor.

• Plans, assigns, and directs the work of the Utilization Review team for all InterMed offices, including day-to-day operational oversight. • Determines appropriate caseloads that allow for timeliness of requests and productivity that meets expectations. • Provides ongoing advice, mentoring, coaching, counseling, and performance feedback to assigned staff. • Completes performance reviews for all personnel within the assigned unit in a timely manner. • Deals quickly and decisively with personnel issues as they arise; keeps the supervisor informed on the need for, or progress of, corrective action. • Authorizes time-off requests to ensure coverage necessary to maintain service guidelines. • Performs weekly audits of more than 10% of reviews per UR Nurse to validate accuracy and completeness of the utilization review process, and conducts comparable periodic audits of Medical Management Coordinator work product. • Serves as InterMed's compliance officer, ensuring compliance with state and URAC regulations. • Participates as an active member of InterMed's Quality Management Program Committee, including quarterly meetings to discuss program improvements, measurements, assessments, and compliance. • Maintains awareness of potential compromise to a patient's safety on each review and refers concerns to the proper authority. • Requires comprehensive knowledge of Utilization Review guidelines in the California Labor Code and other states as needed. • Works with the Medical Director to ensure compliance with Utilization Review guidelines. • Oversees training of new staff on computer systems and on UR policies and procedures. • Provides training for Intercare claims team at various locations to ensure timely and accurate workflow. • Exhibits a knowledgeable and helpful attitude and projects a professional image on behalf of InterMed and Intercare. • Fosters teamwork and cooperation between UR staff and other departments at InterMed, Intercare, and client organizations. • Notifies the supervisor of potential client issues and works toward resolution. • Assists with the implementation of new accounts, with input from account management, and supports staff compliance with client service instructions. • Works effectively with peers across departments, demonstrating professionalism, respect, and a team-oriented approach. • Uses plain language to communicate, in writing and verbally, with injured workers, claims examiners, and clients. • Maintains production performance and savings reports for management review. • Leverages AI and office productivity tools to support project management and reporting workflows. • Handles other duties and tasks as assigned by leadership.

• Reports directly to the unit Claims Supervisor • Provide technical backup in the absence of the Claims Supervisor • Manage an assigned inventory of claim files • Perform a three-point contact on all new losses • Document ongoing case facts and information for compensability • Ensure up to date plan of action for indemnity claims • Partner with medical case manager for early return to work • Refer cases with suspected fraud to SIU • Pursue subrogation from culpable third parties • Review and approve all vocational rehabilitation plans • Monitor and adjust monetary case reserves • Review medical bills for appropriateness prior to payment referral • Maintain a courteous and helpful attitude and project a professional image

• Reports directly to the unit Claims Supervisor • Provide technical backup in the absence of the Claims Supervisor • Manage an assigned inventory of claim files that may include complex cases • Conduct a three-point contact on all new losses within 24 hours of receipt • Document relevant facts surrounding incidents and treatment status • Assure claims have an up-to-date plan of action • Partner with the medical case manager for early return to work potential • Initiate referrals for suspected fraud cases • Pursue subrogation from culpable third parties • Review and approve vocational rehabilitation plans • Monitor and adjust monetary case reserves when warranted • Exhibit a professional image and respond to inquiries within specified timeframes

• Maintain culture of positivity, respect, supportiveness, collaboration, patience, accountability, and excellence • Assist with team building ideas and events • Lead by example and through service • Develop and maintain strong and collaborative client relationships • Establish prompt contact on all new losses within 24 hours of receipt of the claim to include the insured, claimant, or claimant representative to document relevant facts surrounding the incident itself as well to obtain information relevant to analysis of liability and damages • Thoroughly and accurately evaluate coverage on a timely basis, document coverage analysis, identify coverage issues and draft appropriate coverage letters • Thoroughly and accurately investigate all claims and document ongoing case facts and relevant information necessary for establishing liability and damages, perform and document ongoing analysis and evaluation and document what is being done to move the case toward closure • Litigation management - Direct, manage, and control the litigation process for nationwide programs • Assure that all assigned claims are maintained on an active 30 to 45 diary and have an up-to-date plan of action outlining activities and actions anticipated for ultimately resolving the claim • Obtain consultant and/or expert reviews for early evaluation • Aggressively pursue contribution on multiple defendant cases or where provided by employment or independent contractor agreements and apportionment when there is shared liability • Assure that the claim file is handled in accordance with applicable statutes as well as in-force service contracts and company guidelines • Establish, monitor, and adjust claim reserves in strict accordance with assigned authority levels and client claim handling instructions • Exhibit and maintain a courteous and helpful attitude and project a professional image on behalf of the company and client • Respond to telephone messages and inquiries within 24 hours of receipt and to written inquiries within one week of receipt • Travel for mediations, trials, client meetings and/or industry related conferences • Requires a working knowledge of medical terminology and various jurisdictional issues • Handle other duties and tasks as deemed appropriate by the Supervisor or Manager

• Investigate, analyze, and determine the extent of insurance provider's liability concerning personal, casualty, or property loss or damages, and attempt to effect settlement with claimants • Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information • Calculate benefit payments and approve payment of claims within a certain monetary limit • Investigate claims: Assess and estimate vehicle damage • Assist with business or managerial research • Compile information through interviews • Evaluate customer records • Examine evidence to determine if it will support claims • Follow contract, property, or insurance laws • Follow rules of evidence procedures in legal setting • Gather physical evidence • Inspect property to determine damages • Research property records • Search legal records • Interviews, telephones, and or corresponds with claimant and witnesses • Evaluate liability exposure: Review insurance applications • Review insurance policies to determine appropriate coverage • Obtain, review and evaluate records, police, medical, etc. • Recommend claim action • Properly reserve for the claim. Adjust reserve as appropriate • Comply with accepted guidelines regarding reserving practice and authority levels • Create and maintain records Maintain records, reports, and files which are primarily found on the SIMS and/or Renaissance system • Maintain all cases on an active diary on the SIMS and/or Renaissance system pursuant to established Company criteria • Prepare timely reports to clients. Comply with all reporting requirements/steps set out in the GHC Procedure Manual • Comply with regulatory requirements • Diary spoken or written information • Litigation management support: Collect evidence to support contested claims in court • Keep clients advised • Other duties as assigned

• Compiles and analyzes financial information to prepare entries to accounts, such as general ledger accounts, documenting business transactions. • Distributes expenditures, encumbrances, receipts, and receivables according to schedules. • Performs statistical analyses to determine trends, estimates, and significant changes, and writes narrative reports explaining findings. • Analyzes financial information detailing assets, liabilities, and capital, and prepares balance sheet, profit and loss statement, and other reports to summarize and interpret current and projected company financial position for other managers. • Audits contracts, orders, and vouchers, and prepares reports to substantiate individual transactions prior to settlement. • Determines proper handling of financial transactions and approves transactions within designated limits. • Monitors compliance with generally accepted accounting principles and company procedures. • Reviews, investigates, and corrects errors and inconsistencies in financial entries, documents, and reports. • Installs, modifies, documents, and coordinates implementation of accounting systems and accounting control procedures. • Devises and implements system for general accounting. • Makes recommendations regarding the accounting of reserves, assets, and expenditures. • Conducts studies and submits recommendations for improving the organization's accounting operation. • Collects appropriate data and prepares federal, state, and local reports and tax returns. • Handles other duties and tasks as deemed appropriate by the Supervisor or Manager.

• Review and process incoming legal invoices and receipts using ResolveStar • Audit invoices for compliance with client-specific litigation management guidelines • Identify and flag billing errors, discrepancies, or policy violations • Manage invoice approval workflows from submission through payment • Generate reports and track litigation costs in real time • Communicate with law firms to resolve invoice corrections or disputes • Maintain accurate records and audit trails for all invoice transactions • Additional administrative tasks within the department as needed

• Own the Azure Fabric architecture end-to-end: workspace topology, OneLake / Iceberg storage strategy, dev/test/prod separation, capacity sizing, governance • Lead a 4-person surge team (Data Architect, two Data Engineers, Business Analyst) through a 6-month build • Define the Bronze ? Silver ? Semantic layered architecture, with a Gold semantic schema expressed in AvonRisk business terms so reports, dashboards, and AI models survive future claims-platform migrations • Drive the Fabric Mirroring validation for our claims system and design the ADF fallback where Mirroring isn't viable • Architect multi-tenant PHI security: client-segregated PHI workspace + masked cross-tenant analytics layer, with RLS and Fabric secure data sharing for client portal access • Stand up the customer-facing analytics portal (Power BI Embedded or Fabric-native) with a 10+ client pilot live by end of Month 6 • Establish data catalog, lineage, DQ, and governance using Microsoft Purview and Fabric-native tools • Operate the platform as a permanent capability — uptime, performance, capacity, cost • Onboard additional source systems as AvonRisk grows through acquisition and new programs • Build the AI/ML feature foundation that underpins our agent roadmap • Collaborate closely with product builders, claims operations, and client-facing teams to keep the semantic model aligned with business needs

• Reports directly to the unit Claims Supervisor • Effectively managing an assigned inventory of claim files • Perform a three-point contact on all new losses within 24 hours • Accurately document ongoing case facts and relevant information • Form a partnership with the medical case manager • Initiate the referral to the SIU of cases with suspected fraud • Review and approve all vocational rehabilitation plans • Establish, monitor, and adjust monetary case reserves when warranted • Respond to telephone messages and inquiries within 24 hours