Senior Claims Specialist, Workers' Compensation

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

📋 Description

• Manage intricate and prominent Workers’ Compensation claims in accordance with company protocols.

• Receive Workers’ Compensation claims, verifying policy coverage and acknowledging claims.

• Assess claim validity and compensability through thorough investigation and data collection.

• Submit required claim documentation to state agencies.

• Set 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.

• Facilitate early return-to-work initiatives.

• Oversee claim subrogation and litigation processes.

• Manage potential recoveries from claims.

• Report claims to the excess carrier when necessary.

• Update customers and claimants on claim status.

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

• Build and sustain professional relationships with customers.

• Adhere to relevant state laws, regulations, and workplace safety standards.

• Perform additional responsibilities as assigned.

⛳️ Requirements

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

• At least 3 years of experience in the industry and claim management.

• Self-Insured Certificate is preferred.

• State Certification or license as a seasoned claims adjuster.

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

• Exceptional written and verbal communication abilities.

• Capability to assist teammates in enhancing their knowledge and understanding of claims practices.

• Proficient in identifying, analyzing, and resolving issues.

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

• Strong interpersonal, organizational, and time management skills.

• Ability to operate independently as well as collaboratively within a team setting.

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

🏝️ Benefits

• Medical (HDHP) with Pharmacy coverage.

• Dental insurance.

• Vision insurance.

• Long Term Disability coverage.

• Health Savings Account options.

• Flexible Spending Account options.

• Life Insurance.

• Accident Insurance.

• Critical Illness Insurance.

• Pre-paid Legal Insurance.

• Parking and Transit FSA accounts.

• 401K.

• ROTH 401K.

• Paid time off.

• Opportunities for career advancement.

• Remote work options.