Senior Claims Specialist

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

📋 Description

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

• Receive claims, confirming policy coverage and acknowledging the claim.

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

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

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

• Facilitate early return-to-work initiatives.

• Oversee claim subrogation and litigation processes.

• Manage potential recoveries related to claims.

• Report claims to excess carriers when necessary.

• Keep customers and claimants informed about the status of their claims.

• Follow client and carrier guidelines, participating in claims reviews.

• Build and nurture professional relationships with customers.

• Adhere to relevant state laws, regulations, safety protocols, and the Injury and Illness Prevention Program.

• Assist the Claims Department and CorVel in achieving its objectives; perform additional responsibilities as required.

⛳️ Requirements

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

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

• Preferred: Self-Insured Certificate.

• State Certification or license as an experienced claims adjuster.

• Must maintain a current license or certification in Workers’ Compensation throughout employment with CorVel.

• Exceptional written and verbal communication abilities.

• Proficiency in identifying, analyzing, and resolving issues.

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

• Strong interpersonal, time management, and organizational capabilities.

• Capacity to work independently as well as collaboratively within a team setting.

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

• Candidates must reside in California.

🏝️ Benefits

• Medical (HDHP) with Pharmacy coverage.

• Dental insurance.

• Vision insurance.

• Long Term Disability coverage.

• Health Savings Account (HSA).

• Options for Flexible Spending Accounts (FSA).

• Life Insurance.

• Accident Insurance.

• Critical Illness Insurance.

• Pre-paid Legal Insurance.

• Parking and Transit FSA accounts.

• 401K plan.

• ROTH 401K option.

• Paid time off.

• Opportunities for career advancement.

• A supportive company culture.