CA Senior Claims Specialist

CorVel Corporation

Folsom (CA)

Remote

USD 40,000 - 65,000

Full time

12 hours ago

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Benefits offered by this job

Medical (HDHP) w/Pharmacy

Dental

Vision

Long Term Disability

Health Savings Account

401K

ROTH 401K

Paid time off

Parking and Transit FSA accounts

Job summary

CorVel Corporation invites applications for a Senior Workers’ Compensation Claims Specialist. This remote role handles complex WC claims, works with case managers and attorneys, and manages subrogation and settlements to achieve favorable outcomes while meeting client service standards.

Responsibilities include reserving, investigation, return-to-work coordination, and communicating status to customers. Requires 3+ years in claims handling, state licensure, and relevant certifications;

Qualifications

Bachelor’s degree or combination of education and related experience.
Minimum of 3 years’ industry experience and claim handling.
Self-Insured Certificate preferred.
State Certification or license as an experienced claims adjuster.
Current license or certification in Workers’ Compensation must be maintained.

Responsibilities

Receives Workers’ Compensation claim, confirms policy coverage and acknowledgement of the claim.
Determines validity and compensability by investigating and gathering information and files necessary documentation with state agencies.
Establishes reserves and authorizes payments within reserving authority limits.
Develops action plans with the case manager and outcomes manager to reduce overall cost of the claim.
Coordinates early return-to-work efforts with the appropriate parties.
Manages subrogation and litigation of claim as it applies.
Manages potential claim recoveries of all types.
Reports claims to the excess carrier when applicable.
Communicates claim status with the customer and claimant.
Adheres to client and carrier guidelines and participates in claims review as needed.
Develops and maintains professional customer relationships.
Complies with state rules and regulations.
Complies with IIPP safety rules during working hours.
Additional duties as assigned.

Skills

Written communication

Verbal communication

Team collaboration

Analytical thinking

Time management

Organizational skills

Claims knowledge

Microsoft Office

Education

Bachelor’s degree

Self-Insured Certificate preferred

State certification or license as an experienced claims adjuster

Workers’ Compensation license/certification

Tools

MS Office

Excel

Job description

The WC Senior Claims Specialist handles complex and high-profile Workers' Compensation claims following company standards. This role works closely with case managers and attorneys, manages subrogation, and negotiates settlements. The Senior Claims Specialist ensures the best possible outcome for the claim, meeting customer service expectations, and supporting the goals of the Claims Department and CorVel.

This is a remote position.

Essential Functions & Responsibilities

Receives Workers’ Compensation claim, confirms policy coverage and acknowledgement of the claim
Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies
Establishes reserves and authorizes payments within reserving authority limits
Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim
Coordinates early return-to-work efforts with the appropriate parties
Manages subrogation and litigation of claim as it applies
Manages potential claim recoveries of all types
Reports claims to the excess carrier when applicable
Communicates claim status with the customer and claimant
Adheres to client and carrier guidelines and participates in claims review as needed
Develops and maintains professional customer relationships
Complies with rules and regulations of applicable state
Complies with all safety rules and regulations during working hours in conjunction with the Injury and Illness Prevention Program ("IIPP")
Additional duties as assigned

Knowledge & Skills

Excellent written and verbal communication skills
Ability to assist team members to develop knowledge and understanding of claims practice
Ability to identify, analyze and solve problems
Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Excel spreadsheets
Strong interpersonal, time management and organizational skills
Ability to work both independently and within a team environment
Knowledge of the entire claims administration, case management and cost containment solution as applicable to Workers’ Compensation

Education & Experience

Bachelor's degree or a combination of education and related experience
Minimum of 3 years’ industry experience and claim handling
Self-Insured Certificate preferred
State Certification or license as an experienced claims adjuster
Current license or certification in Workers’ Compensation must be maintained throughout employment with CorVel

PAY RANGE

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $29.35 - $47.28 per hour

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

About Corvel

CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).