CA Senior Claims Specialist

CorVel Corporation•Rancho Cucamonga, CA

7d•$29 - $47•Remote

About The Position

The Workers’ Compensation Senior Claims Specialist handles complex and high-profile claims in accordance with company standards. The role works closely with case managers and attorneys, manages subrogation, litigation, and potential recoveries, and negotiates settlements to achieve the best possible claim outcomes while meeting customer service expectations and supporting the goals of the Claims Department and CorVel. This is a remote position. The specialist receives and investigates claims, confirms policy coverage, determines compensability, establishes reserves, authorizes payments within authority limits, and files required documentation with state agencies. They develop and manage documented action plans with case managers and outcomes managers to reduce claim costs, coordinate early return-to-work efforts, report claims to excess carriers when applicable, and communicate claim status to customers and claimants. The role also adheres to client, carrier, and state requirements; participates in claims reviews as needed; maintains professional customer relationships; and follows applicable safety rules. Candidates should have a bachelor’s degree or an equivalent combination of education and related experience, at least three years of industry and claim-handling experience, and a current Workers’ Compensation license or certification that is maintained throughout employment. State certification or licensure as an experienced claims adjuster is required; a Self-Insured Certificate is preferred.

Requirements

Bachelor’s degree or a combination of education and related experience.
At least 3 years of industry experience and claim handling.
State certification or license as an experienced claims adjuster.
Current Workers’ Compensation license or certification, maintained throughout employment with CorVel.
Excellent written and verbal communication skills.
Ability to assist team members in developing knowledge and understanding of claims practice.
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.

Responsibilities

Receive Workers’ Compensation claims, confirm policy coverage, and acknowledge claims.
Investigate claims, determine validity and compensability, gather information, 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 litigation as applicable to claims.
Manage potential claim recoveries of all types.
Report claims to the excess carrier when applicable.
Communicate claim status to 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.
Comply with safety rules and regulations during working hours in conjunction with the Injury and Illness Prevention Program.
Perform additional duties as assigned.