CA Senior Claims Specialist

Ultipro; Folsom, Northern (CA, KY); On-site; USD 85,000 - 115,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) plan

Paid time off

Job summary

CorVel is seeking a Senior Workers’ Compensation Claims Specialist to manage complex claims, coordinate with case managers and attorneys, and oversee subrogation and settlements. This remote role emphasizes customer service and adherence to client and carrier guidelines.

The position requires a bachelor’s degree or equivalent, at least 3 years of claims experience, and appropriate state licensure. A comprehensive benefits package accompanies full-time employment.

Qualifications

• Bachelor’s degree or equivalent in a related field or experience.
• Minimum 3 years’ industry experience with claim handling.
• State certification or license as a claims adjuster is required.
• Current Workers’ Compensation licensing must be maintained.

Responsibilities

• Receive WC claims, confirm policy coverage and claim acknowledgement.
• Determine validity and compensability by investigation and documentation.
• Establish reserves and authorize payments within limits.
• Develop action plans with case managers to reduce costs.
• Coordinate early return-to-work with relevant parties.
• Manage subrogation, litigation, and recoveries as applicable.
• Report claims to excess carriers when needed.
• Communicate claim status to customers and claimants.
• Adhere to guidelines and participate in reviews; maintain professional relationships.
• Comply with state regulations and IIPP safety rules.

Education

Bachelor's degree or related experience

Self-Insured Certificate

State certification or license as claims adjuster

Workers’ Compensation license

Tools

Microsoft 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 serviceexpectations, 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.

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!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.