Senior Claims Specialist

This is a fully remote position, open to applicants in California.

📋 Description

• Manage intricate and high-profile Workers’ Compensation claims in accordance with company protocols.

• Verify policy coverage and acknowledge claims received.

• Investigate claims to assess their validity and compensability, filing necessary documentation with state authorities.

• Set reserves and authorize payments within established reserving authority limits.

• Create and oversee documented action plans with case managers and outcomes managers to effectively reduce claim costs.

• Facilitate early return-to-work initiatives.

• Oversee claim subrogation, litigation, and potential recoveries.

• Notify excess carriers of claims when appropriate.

• Keep customers and claimants informed about claim status.

• Comply with client, carrier, state, and safety regulations.

• Engage in claims reviews as necessary.

• Build and sustain professional relationships with customers.

• Collaborate closely with case managers and attorneys to support the Claims Department and CorVel objectives.

• Carry out additional responsibilities as assigned.

⛳️ Requirements

• Bachelor’s degree or a combination of education and relevant experience.

• At least 3 years of industry experience and claim handling expertise.

• California self-insured license is mandatory.

• State certification or license as a qualified claims adjuster.

• Current license or certification in Workers’ Compensation must be maintained throughout employment.

• Bilingual proficiency in Spanish is required.

• Exceptional written and verbal communication skills.

• Capability to assist team members in enhancing claims-practice knowledge.

• Proficiency in identifying, analyzing, and resolving issues.

• Computer skills and technical aptitude, including proficiency in Microsoft Office and Excel spreadsheets.

• Strong interpersonal, time management, and organizational abilities.

• Capacity to work independently as well as part of a team.

• Familiarity with claims administration, case management, and cost-containment strategies relevant to Workers’ Compensation.

🏝️ Benefits

• Medical (HDHP) with Pharmacy.

• Dental coverage.

• Vision benefits.

• Long Term Disability insurance.

• Health Savings Account.

• Options for Flexible Spending Accounts.

• Life insurance coverage.

• Accident insurance.

• Critical Illness insurance.

• Pre-paid Legal Insurance.

• Parking and Transit FSA accounts.

• 401K plan.

• ROTH 401K plan.

• Paid time off.

• Opportunities for career advancement.

• Supportive work culture.