CA Claims Specialist

CorVel; Rancho Cucamonga (CA); Remote; USD 50,000 - 70,000; Full time

Job summary

A leading company in claims management is seeking a Claims Specialist to manage non-complex workers’ compensation claims. This remote role involves confirming policy coverage, establishing reserves, and communicating with clients. Ideal candidates will have strong communication skills and a Bachelor's degree, along with relevant experience in claims management.

Qualifications

• Minimum of 1 year of industry experience and claims management preferred.
• State Certification as an Experienced Examiner.

Responsibilities

• Manages lower-level workers’ compensation claims under supervision.
• Determines validity and compensability of claims.
• Communicates claim status with customers and clients.

Skills

Communication

Problem Solving

Time Management

Organizational Skills

Education

Bachelor's degree

Tools

MS Office

Job description

The Claims Specialist manages, within company best practices, lower-level, non-complex, and non-problematic workers’ compensation claims within delegated limited authority to achieve the best possible outcome, under the direct supervision of a senior claims professional. This role supports the goals of the claims department and of CorVel.

This is a remote position.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

1. Receives claims, confirms policy coverage, and acknowledges the claim.
2. Determines validity and compensability of the claim.
3. Establishes reserves and authorizes payments within reserving authority limits.
4. Manages non-complex and non-problematic medical-only claims and minor lost-time workers’ compensation claims under close supervision.
5. Communicates claim status with the customer, claimant, and client.
6. Adheres to client and carrier guidelines and participates in claims review as needed.
7. Assists other claims professionals with more complex or problematic claims as necessary.
8. Requires regular and consistent attendance.
9. Complies with all safety rules and regulations during working hours in conjunction with the Injury and Illness Prevention Program (“IIPP”).
10. Performs additional projects and duties as assigned.

KNOWLEDGE & SKILLS:

1. Excellent written and verbal communication skills.
2. Ability to learn rapidly to develop knowledge and understanding of claims practice.
3. Ability to identify, analyze, and solve problems.
4. Computer proficiency and technical aptitude with the ability to utilize MS Office, including Excel spreadsheets.
5. Strong interpersonal, time management, and organizational skills.
6. Ability to meet or exceed performance competencies.
7. Ability to work both independently and within a team environment.

EDUCATION & EXPERIENCE:

1. Bachelor's degree or a combination of education and related experience.
2. Minimum of 1 year of industry experience and claims management preferred.
3. State Certification as an Experienced Examiner.