CA Senior Claims Specialist

CorVel Corporation; Rancho Cucamonga (CA); Remote; USD 85,000 - 110,000; Full time

Job summary

CorVel Corporation is seeking a WC Senior Claims Specialist for a remote role based in the United States. The position handles complex workers’ compensation claims, works with case managers and attorneys, and oversees subrogation and settlements to achieve favorable outcomes.

You will determine claim validity, establish reserves, and coordinate early return-to-work efforts while maintaining strong customer relationships and compliance with state rules.

Qualifications

• Bachelor's degree or equivalent; 3+ years workers' compensation claims experience.
• Current license or certification in Workers’ Compensation maintained.
• Self-Insured Certificate preferred; state certification or license as claims adjuster.
• Proficient in claims administration and cost containment practices.

Responsibilities

• Receives Workers’ Compensation claim, confirms policy coverage and acknowledgement of the claim.
• Determines validity and compensability by investigating and filing necessary documentation with state agencies.
• Establishes reserves and authorizes payments within reserving authority limits.
• Develops and manages 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.

Skills

Communication

Teamwork

Problem solving

Time management

Attention to detail

Independent work

Claims knowledge

Education

Bachelor's degree or equivalent

State Certification or license

Self-Insured Certificate preferred

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.