CA WC Senior Claims Specialist (SIP, 4850, PRISM)

CorVel Career Site•Rancho Cucamonga, CA

4d•$29 - $46•Remote

About The Position

We are seeking a Sr. Claims Specialist for our Southern California Team. The Sr. Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department and of CorVel. This position is remote. Candidates must hold a self-insured certificate. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claim, confirms policy coverage and acknowledgement of the claim Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies Establishes reserves and authorizes payments within reserving authority limits Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim Coordinates early return-to-work efforts with the appropriate parties Manages subrogation and litigation of claim as it applies Manages potential claim recoveries of all types Reports claims to the excess carrier when applicable Communicates claim status with the customer and claimant Adheres to client and carrier guidelines and participates in claims review as needed Develops and maintains professional customer relationships Complies with rules and regulations of applicable state Complies with all safety rules and regulations during working hours in conjunction with the Injury and Illness Prevention Program (“IIPP”) Additional duties as assigned KNOWLEDGE & SKILLS: Excellent written and verbal communication skills Ability to assist team members to develop knowledge and understanding of claims practice Ability to identify, analyze and solve problems Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets Strong interpersonal, time management and organizational skills Ability to work both independently and within a team environment Knowledge of the entire claims administration, case management and cost containment solution as applicable to Workers’ Compensation

Requirements

Excellent written and verbal communication skills
Ability to assist team members to develop knowledge and understanding of claims practice
Ability to identify, analyze and solve problems
Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets
Strong interpersonal, time management and organizational skills
Ability to work both independently and within a team environment
Knowledge of the entire claims administration, case management and cost containment solution as applicable to Workers’ Compensation
Bachelor's degree or a combination of education and related experience
4-5 years of California Workers’ Compensation claims handling experience required
CA workers compensation adjuster license required
4850 experience required

Nice To Haves

Associates in Claims or Associates in Risk Management designation preferred

Responsibilities

Receives claim, confirms policy coverage and acknowledgement of the claim
Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies
Establishes reserves and authorizes payments within reserving authority limits
Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim
Coordinates early return-to-work efforts with the appropriate parties
Manages subrogation and litigation of claim as it applies
Manages potential claim recoveries of all types
Reports claims to the excess carrier when applicable
Communicates claim status with the customer and claimant
Adheres to client and carrier guidelines and participates in claims review as needed
Develops and maintains professional customer relationships
Complies with rules and regulations of applicable state
Complies with all safety rules and regulations during working hours in conjunction with the Injury and Illness Prevention Program (“IIPP”)
Additional duties as assigned