Senior Claims Specialist

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

📋 Description

• Manage complex and high-profile Workers' Compensation claims in accordance with company protocols.

• Receive claims, verify policy coverage, and acknowledge receipt of claims.

• Conduct investigations on claims to assess validity and compensability, filing necessary documentation with state agencies.

• Establish reserves and authorize payments within the limits of reserving authority.

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

• Coordinate efforts for early return-to-work initiatives.

• Oversee subrogation and litigation processes.

• Manage potential recoveries related to claims.

• Report claims to the excess carrier when applicable.

• Communicate the status of claims to customers and claimants.

• Adhere to client and carrier guidelines while participating in claims reviews.

• Build and maintain professional relationships with customers.

• Comply with relevant state rules, regulations, and safety standards.

• Perform additional responsibilities as assigned.

⛳️ Requirements

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

• At least 3 years of experience in the industry and handling claims.

• Self-Insured Certificate is preferred.

• State Certification or license as an experienced claims adjuster is required.

• A current license or certification in Workers’ Compensation must be maintained throughout employment with CorVel.

• Exceptional written and verbal communication skills.

• Ability to assist team members in developing knowledge and understanding of claims practices.

• Strong problem identification, analysis, and solving skills.

• Proficiency in computer skills and technical aptitude, including Microsoft Office and Excel spreadsheets.

• Excellent interpersonal, time management, and organizational abilities.

• Capability to work both independently and collaboratively within a team environment.

• Knowledge of the entire claims administration, case management, and cost containment solutions relevant to Workers’ Compensation.

• Must be a resident of California.

🏝️ Benefits

• Medical (HDHP) with Pharmacy coverage.

• Dental insurance.

• Vision coverage.

• Long Term Disability insurance.

• Health Savings Account.

• Options for Flexible Spending Accounts.

• Life Insurance.

• 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.

• Option for remote work.