Medical Only Claims Specialist

CorVel Corporation; Folsom (CA); Remote; USD 50,000 - 70,000; Full time

Job summary

A leading company in risk management solutions is seeking a Medical Only Claims Specialist. This remote position involves managing non-complex claims, ensuring compliance with guidelines, and supporting clients. Ideal candidates will have strong communication skills and a Bachelor's degree, along with relevant experience. The role offers a comprehensive benefits package and opportunities for career advancement.

Benefits

Medical (HDHP) w/Pharmacy

Dental

Vision

401K

Paid Time Off

Qualifications

• Minimum of 1 year industry experience and claim handling.
• WC experience required.

Responsibilities

• Manages non-complex medical only claims and minor lost-time claims.
• 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 Medical Only Claims Specialist manages non-complex and non-problematic, medical only claims and minor lost-time workers’ compensation claims under close supervision, supporting the goals of claims department and of CorVel.

This is a remote position

ESSENTIAL FUNCTIONS& RESPONSIBILITIES:

• Receives claims, confirms policy coverage and acknowledgement of the claim
• Determines the validity and compensability of the claim
• Establishes reserves and authorizes payments within established reserving authority limits
• Communicates claim status with the customer, claimant and client
• Adheres to client and carrier guidelines and participates in claims review as needed
• Assists other claims professionals with more complex or problematic claims as necessary
• Additional projects and duties as assigned

KNOWLEDGE & SKILLS:

• Excellent written and verbal communication skills
• Ability to learn rapidly to develop knowledge and understanding of claims practice, relevant statutes and medical terminology
• 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

EDUCATION/EXPERIENCE:

• Bachelor's degree or a combination of education and related experience
• Minimum of 1 year industry experience and claim handling
• WC experience required
• Licensed as required jurisdictionally

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.