Workers' Compensation EDI Specialist I

CorVel is seeking an experienced and detail-oriented specialist to join our State Filing team, focusing on the timely and accurate submission of First Reports of Injury (FROI) and Subsequent Reports of Injury (SROI) in compliance with state workers' compensation reporting requirements.

About the role

This remote position requires strong analytical and problem-solving skills, the ability to interpret state-specific EDI implementation guides and reporting matrices, and experience researching claim information to determine appropriate filing actions. A high level of accuracy, independent decision-making, and the ability to manage production expectations in a fast-paced environment are essential.

While direct Workers' Compensation EDI experience is preferred, we welcome candidates with transferable experience in insurance, claims, compliance, data analysis, or other detail-oriented roles who demonstrate strong problem-solving abilities and attention to detail.

Responsibilities

• Prepare, review, and submit Workers' Compensation EDI FROI and SROI transactions utilizing vendor reporting platforms, including EBIX/WCIRS.
• Analyze claim activity and documentation to determine appropriate filings based on state-specific reporting requirements.
• Interpret state implementation guides, EDI reporting matrices, sequencing requirements, and jurisdictional filing rules.
• Research workers' compensation claims within CorVel’s Claim System, CareMC, to obtain required filing information and validate data accuracy.
• Review, investigate, and resolve EDI transaction errors, rejects, and acknowledgments to ensure timely acceptance by state agencies.
• Monitor filing compliance and ensure reports are submitted within required state reporting deadlines.
• Communicate with claims adjusters, account managers, and other internal stakeholders regarding missing or inaccurate claim information needed for reporting.
• Utilize available resources, including CareMC, SharePoint, state workers' compensation websites, and internal procedures to resolve filing issues.
• Stay current on state reporting requirements, IAIABC standards, implementation guide updates, and industry best practices.
• Maintain productivity and quality standards while balancing multiple priorities and deadlines.
• Ensure compliance with HIPAA, privacy regulations, and company policies in all communications and work activities.
• Perform additional duties as assigned.

Requirements

• High School Diploma, GED, or equivalent.
• Minimum one (1) year of experience in an administrative, data entry, customer service, insurance, claims, compliance, or other detail-oriented role.
• Demonstrated ability to work accurately in a fast-paced environment while managing multiple priorities and deadlines.

Qualifications

• Strong attention to detail and commitment to data accuracy.
• Ability to analyze complex information and make sound filing decisions based on state reporting requirements.
• Understanding of workers' compensation claims processes and terminology.
• Ability to interpret and apply state-specific EDI implementation guides, reporting matrices, and sequencing requirements.
• Strong critical thinking and problem-solving skills.
• Experience researching and resolving reporting errors and data discrepancies.
• Effective time management and prioritization skills in a production-based environment.
• Ability to independently manage workload while meeting deadlines and performance expectations.
• Strong verbal and written communication skills.
• Proficiency with Microsoft Office Suite, particularly Outlook, Excel, and Word.
• Ability to work effectively across multiple applications and systems in a paperless environment.
• Strong organizational skills and adaptability in a changing regulatory environment.

Preferred Qualifications

• Experience in Workers' Compensation claims, claims administration, insurance operations, EDI reporting, regulatory compliance, or a related field.
• Knowledge of Workers' Compensation terminology, claim processes, and state reporting requirements.
• Experience with First Reports of Injury (FROI), Subsequent Reports of Injury (SROI), EDI transactions, or electronic regulatory reporting.
• Familiarity with IAIABC standards, state implementation guides, or reporting compliance requirements.
• Experience researching and resolving data discrepancies, reporting errors, or rejected transactions.
• Associate's degree or coursework in Business, Insurance, Healthcare Administration, Information Systems, or a related field.

Pay

CorVel uses a market-based approach to pay, with salary ranges varying by location. Pay rates consider federal, state, and local minimum wage requirements, geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. The pay range for this role is $16.54 - $24.95 per hour.

Benefits

A comprehensive benefits package is available for full-time regular employees, including:

• Medical (HDHP) with Pharmacy
• Dental and Vision
• Long Term Disability
• Health Savings Account and Flexible Spending Account options
• Life Insurance, Accident Insurance, and Critical Illness Insurance
• Pre-paid Legal Insurance
• Parking and Transit FSA accounts
• 401K and ROTH 401K
• Paid time off

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. Founded in 1987 and publicly traded on the NASDAQ since 1991, CorVel invests in human capital and technology to deliver innovative and integrated solutions. With over 4,000 employees across the United States, CorVel embraces core values of Accountability, Commitment, Excellence, Integrity, and Teamwork (ACE-IT!).