Senior Claims Specialist, SIP
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Job Description
Senior Claims Specialist managing complex California workers’ compensation claims for CorVel, a national risk-management solutions provider. Investigating claims, controlling costs, coordinating return-to-work efforts, and managing subrogation and settlements.
Responsibilities:
- Manage complex and problematic, high-visibility workers’ compensation claims within delegated limited authority
- Determine benefits due and claim validity/compensability through investigation and information gathering
- Confirm policy coverage and acknowledge claims
- File necessary claim documentation with state agencies
- Establish reserves and authorize payments within authority limits
- Develop and manage action plans with case managers and outcomes managers to reduce claim costs
- Coordinate early return-to-work efforts
- Manage subrogation, litigation, and potential claim recoveries
- Report claims to excess carriers when applicable
- Communicate claim status with customers and claimants
- Adhere to client and carrier guidelines and participate in claims reviews
- Develop and maintain professional customer relationships
- Comply with applicable state rules and regulations
- Work closely with case managers and attorneys and negotiate settlements
Requirements:
- Bachelor's degree or a combination of education and related experience
- 4–5 years of California Workers’ Compensation claims handling experience required
- California workers compensation adjuster license required
- 4850 experience required
- Associates in Claims or Associates in Risk Management designation preferred
- Excellent written and verbal communication skills
- Ability to assist team members in developing claims-practice knowledge
- Ability to identify, analyze, and solve problems
- Computer proficiency and technical aptitude, including MS Office and Excel spreadsheets
- Strong interpersonal, time-management, and organizational skills
- Ability to work independently and within a team environment
- Knowledge of claims administration, case management, and cost-containment solutions applicable to Workers’ Compensation
Benefits:
- 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
- Career advancement opportunities
- Supportive culture
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