Senior Claims Specialist

About the role

The 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 service expectations, and supports the goals of the Claims Department and CorVel.

Responsibilities

• Receives Workers’ Compensation claim, confirms policy coverage and acknowledges the claim
• Determines validity and compensability of the claim by investigating and gathering information regarding the claim and filing 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
• Captures 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

Requirements

Essential Functions & Responsibilities

• Receives Workers’ Compensation claim, confirms policy coverage and acknowledges the claim
• Determines validity and compensability of the claim by investigating and gathering information regarding the claim and filing 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
• Captures 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

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
• Able 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

Qualifications

• 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

Benefits

Pay Range: $61,053 – $98,334

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

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.