Senior Workers' Compensation Claims Specialist

About the role

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 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

Qualifications

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
• 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

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

Benefits

Our benefits package 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

Pay

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.

Schedule

This role is available for both remote and hybrid work arrangements.