CA WC Senior Claims Specialist

CorVel Corporation; Rancho Cucamonga (CA); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a Senior Claims Specialist to manage complex workers' compensation claims remotely. This role involves investigating claims, determining validity, and negotiating settlements to achieve optimal outcomes. You will collaborate closely with case managers while ensuring compliance with state regulations and client guidelines. The company prides itself on a supportive culture, offering a comprehensive benefits package and numerous career advancement opportunities. If you are skilled in claims management and looking for a rewarding position in a stable environment, this opportunity is perfect for you.

Benefits

Medical (HDHP) with Pharmacy

Dental Insurance

Vision Insurance

401K and ROTH 401K

Paid Time Off

Long Term Disability

Health Savings Account

Flexible Spending Account Options

Life Insurance

Accident Insurance

Qualifications

• 3+ years of experience in claims handling required.
• Bachelor's degree or equivalent experience is essential.

Responsibilities

• Manage complex workers' compensation claims and determine benefits due.
• Coordinate with case managers and negotiate settlements.

Skills

Excellent written and verbal communication skills

Problem identification and analysis

Computer proficiency (MS Office, Excel)

Interpersonal skills

Time management and organizational skills

Ability to work independently and in a team

Education

Bachelor's degree

Self-Insured Certificate

State Certification as an experienced Examiner

Job description

The Senior Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; works closely with case managers and attorneys; manages subrogation and negotiates settlements to ensure specific customer service requirements to achieve the best possible outcome in the claim, supporting the goals of the claims department and of CorVel.

This is a remote position.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

• Receives claim, confirms policy coverage and acknowledgment 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.
• Additional projects and 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 MS 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 as an experienced Examiner.

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 the 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 enables 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.