CA Senior Claims Specialist
About The Position
The Senior Claims Specialist handles complex and high-profile Workers’ Compensation claims in accordance with company standards. The role works closely with case managers and attorneys, manages subrogation and litigation as applicable, and negotiates settlements. It is responsible for pursuing the best possible claim outcomes, meeting customer service expectations, and supporting the goals of the Claims Department and CorVel. This is a remote position. The role receives and investigates Workers’ Compensation claims, confirms coverage, determines compensability, establishes reserves, authorizes payments within authority limits, and maintains claim documentation. It develops and manages action plans with case managers and outcomes managers to reduce claim costs, coordinates return-to-work efforts, manages recoveries, and reports claims to excess carriers when applicable. The specialist communicates claim status, follows client, carrier, and state requirements, and maintains professional customer relationships. CorVel is a national provider of risk management solutions for workers’ compensation, auto, health, and disability management. The company describes itself as stable and growing, with career advancement opportunities and a supportive culture. A comprehensive benefits package is available to full-time regular employees.
Requirements
- Bachelor’s degree or a combination of education and related experience.
- At least 3 years of industry experience and claim handling.
- Current license or certification in Workers’ Compensation, maintained throughout employment with CorVel.
- Excellent written and verbal communication skills.
- Ability to help team members develop claims-practice knowledge and understanding.
- 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.
- Knowledge of claims administration, case management, and cost-containment solutions as applicable to Workers’ Compensation.
Nice To Haves
- Self-Insured Certificate preferred.
- State certification or license as an experienced claims adjuster.
Responsibilities
- Receive Workers’ Compensation claims, confirm policy coverage, and acknowledge claims.
- Investigate claims, gather relevant information, determine validity and compensability, and file necessary documentation with state agencies.
- Establish reserves and authorize payments within reserving authority limits.
- Develop and manage documented action plans with case managers and outcomes managers to reduce overall claim costs.
- Coordinate early return-to-work efforts with appropriate parties.
- Manage subrogation and claim litigation as applicable.
- Manage potential claim recoveries of all types.
- Report claims to the excess carrier when applicable.
- Communicate claim status with customers and claimants.
- Adhere to client and carrier guidelines and participate in claims reviews as needed.
- Develop and maintain professional customer relationships.
- Comply with applicable state rules and regulations and workplace safety rules under the Injury and Illness Prevention Program.
- Perform additional duties as assigned.
Benefits
- Medical insurance (HDHP) with pharmacy coverage
- Dental insurance
- Vision insurance
- Long-term disability insurance
- 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
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Senior
