Sr. Claims Specialist

Employer
CorVel Corporation
Location
Tampa, Florida
Salary
Not Specified
Posted
Feb 16, 2021
Closes
Apr 11, 2021
Ref
6514984#GIJtoGJS.4
Industry
Insurance
Category
Insurance

JOB SUMMARY:

The Sr. Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department and of CorVel.

ABOUT CORVEL:

CorVel 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 3,500 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.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

  • Receives claim, confirms policy coverage and acknowledgement of the claim
  • Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files 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
  • Coordinates 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
  • Additional projects and duties as assigned

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 MS Office including Excel spreadsheets
  • Strong interpersonal, time management and organizational skills
  • Ability 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

EDUCATION/EXPERIENCE:

  • Bachelor's degree or a combination of education and related experience
  • 10 + years experience handling Florida Workers Compensation lost time claims
  • Florida workers compensation adjuster license required
  • Associates in Claims or Associates in Risk Management designation preferred

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