CA Senior Claims Specialist
About The Position
The Senior Claims Specialist handles complex and high-profile Workers’ Compensation claims according to company standards. The role works closely with case managers and attorneys, manages subrogation, litigation, and claim recoveries, and negotiates settlements. It is responsible for achieving 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 investigates claims, confirms coverage and compensability, establishes reserves, authorizes payments within applicable authority limits, coordinates return-to-work efforts, and communicates claim status with customers and claimants. It also maintains compliance with client, carrier, and state requirements and applicable safety rules. CorVel describes itself as a national provider of risk management solutions for workers’ compensation, auto, health, and disability management. The company reports that it was founded in 1987, has been publicly traded since 1991, and has more than 4,000 employees across the United States. Full-time regular employees are offered a comprehensive benefits package.
Requirements
- Bachelor’s degree or a combination of education and related experience.
- At least 3 years of industry experience and claim-handling experience.
- Current Workers’ Compensation license or certification, maintained throughout employment.
- 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 as part of a team.
- 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.
- Determine claim validity and compensability by investigating and gathering information, and file necessary documentation with state agencies.
- Establish reserves and authorize payments within reserving authority limits.
- Develop and manage documented action plans with the case manager and outcomes manager to reduce overall claim costs.
- Coordinate early return-to-work efforts with appropriate parties.
- Manage claim subrogation and litigation, as applicable.
- 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 and workplace safety rules under the Injury and Illness Prevention Program.
- Perform additional duties as assigned.
Benefits
- Medical (HDHP) with pharmacy
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Senior
