Medical Only Claims Specialist

CorVel Career Site•Portland, OR

3d•Remote

About The Position

The Workers’ Compensation Medical Only Claims Specialist manages non-complex, non-problematic medical-only claims under close supervision, supporting the goals of the Claims Department and CorVel. This is a remote position. The role receives Workers’ Compensation claims, confirms policy coverage and claim acknowledgement, determines claim validity and compensability, establishes reserves, authorizes payments within established authority limits, and communicates claim status with customers, claimants, and clients. The specialist follows client and carrier guidelines, participates in claims reviews as needed, and assists other claims professionals with more complex or problematic claims. Additional duties may be assigned. The position requires customer service and communication skills, the ability to learn claims practices, relevant statutes, and medical terminology, and the ability to identify, analyze, and solve problems. Candidates need computer proficiency and technical aptitude to use Microsoft Office, including Excel, as well as strong interpersonal, time-management, and organizational skills. The specialist must be able to work independently and as part of a team. A bachelor’s degree or a combination of education and related experience is required. At least one year of industry experience and claim handling is required, as is Workers’ Compensation experience. Licensing is required where applicable.

Requirements

Excellent customer service skills.
Excellent written and verbal communication skills.
Ability to learn claims practices, relevant statutes, and medical terminology.
Ability to identify, analyze, and solve problems.
Computer proficiency and technical aptitude, including use of Microsoft Office and Excel spreadsheets.
Strong interpersonal, time-management, and organizational skills.
Ability to work independently and within a team environment.
Bachelor’s degree or a combination of education and related experience.
Minimum of 1 year of industry experience and claim handling.
Workers’ Compensation experience.
Licensure as required by the applicable jurisdiction.

Responsibilities

Receive Workers’ Compensation claims and confirm policy coverage and claim acknowledgement.
Determine the validity and compensability of claims.
Establish reserves and authorize payments within established reserving authority limits.
Communicate claim status with the customer, claimant, and client.
Adhere to client and carrier guidelines and participate in claims reviews as needed.
Assist other claims professionals with more complex or problematic claims as necessary.
Perform additional duties as assigned.