Medical Only Claims Specialist

CorVel Brand; Portland (OR); Remote; USD 60,000 - 80,000; Full time

Benefits offered by this job

Medical (HDHP) with Pharmacy

Dental

Vision

401K

Paid time off

Parking and Transit

Job summary

CorVel is seeking a Workers’ Compensation Medical Only Claims Specialist to work remotely. This role supports the Claims Department by handling non-complex medical-only claims under supervision, ensuring coverage and valid compensability while maintaining timely communications with clients and claimants.

The position requires a bachelor’s degree or related experience, at least 1 year of WC claims experience, and jurisdictional licensing as needed.

Qualifications

• Bachelor's degree or equivalent experience in claims.
• Minimum 1 year workers’ compensation claims experience.
• Licensed as required by the jurisdiction.

Responsibilities

• Receive workers’ compensation medical claims and confirm coverage.
• Determine validity and compensability of claims.
• Establish reserves and authorize payments within limits.
• Communicate claim status to customers, claimants and clients.
• Assist other claims professionals with more complex claims.
• Adhere to guidelines and participate in reviews as needed.

Skills

Communication skills

Problem solving

MS Excel

Time management

Teamwork

Independence

Education

Bachelor's degree

1 year workers' comp experience

Tools

Microsoft Office

Office software

Job description

The Workers’ Compensation Medical Only Claims Specialist manages non-complex and non-problematic, medical only claims under close supervision, supporting the goals of the Claims Department and of CorVel.

This is a remote position

ESSENTIAL FUNCTIONS & RESPONSIBILITIES

• Receives Workers’ Compensation 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 duties as assigned

KNOWLEDGE & SKILLS

• Excellent written and verbal communication skills
• Fast learner; develops knowledge and understanding of claims practice, relevant statutes, and medical terminology
• Ability to identify, analyze and solve problems
• Computer proficiency and technical aptitude to utilize Microsoft 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
• Workers’ Compensation 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
• 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.