Medical Only Claims Specialist
About The Position
The Medical Only Claims Specialist manages non-complex, non-problematic workers’ compensation medical-only claims under close supervision. The role supports the goals of the Claims Department and CorVel and is remote. The specialist receives workers’ compensation claims, confirms policy coverage and claim acknowledgement, determines claim validity and compensability, establishes reserves, and authorizes payments within established authority limits. The role communicates claim status with customers, claimants, and clients, follows client and carrier guidelines, participates in claims reviews as needed, and assists other claims professionals with more complex or problematic claims. This position requires workers’ compensation experience, at least one year of industry experience and claim handling, and licensing as required by the jurisdiction. A bachelor’s degree or a combination of education and related experience is required.
Requirements
- Excellent customer service skills.
- Excellent written and verbal communication skills.
- Ability to learn quickly and develop knowledge of claims practice, 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 required.
- Licensed as required jurisdictionally.
Responsibilities
- Receive workers’ compensation claims and confirm policy coverage and acknowledgement of the claim.
- 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 review as needed.
- Assist other claims professionals with more complex or problematic claims as necessary.
- Perform additional duties as assigned.
Benefits
- Medical (HDHP) with pharmacy
- Dental insurance
- Vision insurance
- Long-term disability
- Health Savings Account
- Flexible Spending Account options
- Life insurance
- Accident insurance
- Critical illness insurance
- Pre-paid legal insurance
- Parking and Transit FSA accounts
- 401(k)
- ROTH 401(k)
- Paid time off
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
