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Medical Only Claims Specialist

4 months ago

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The Medical Only Claims Specialist manages non-complex and non-problematic, medical only claims and minor lost-time workers' compensation claims under close supervision, supporting the goals of claims department and of CorVel.

This is a hybrid role reporting to our Dublin, OH office. Candidates must live within 30 minutes of Dublin, OH to be considered.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

  • Receives claims, confirms policy coverage and acknowledgement of the claim
  • Determines the validity and compensability of the claim
  • Establishes reserves and authorizes payments within established reserving authority limits
  • Communicates claim status with the customer, claimant and client
  • Adheres to client and carrier guidelines and participates in claims review as needed
  • Assists other claims professionals with more complex or problematic claims as necessary
  • Additional projects and duties as assigned

KNOWLEDGE & SKILLS:

  • Excellent Customer Service Skills
  • Excellent written and verbal communication skills
  • Ability to learn rapidly to develop knowledge and understanding of claims practice, relevant statutes and medical terminology
  • 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

EDUCATION/EXPERIENCE:

  • Bachelor's degree or a combination of education and related experience
  • Minimum of 1 year industry experience and claim handling
  • Self-insured Ohio WC Claims experience required
  • West Virginia claims experience and license is preferred. If not licensed in WV, must be willing to obtain your WV license during employment.
  • WC experience required
  • Licensed as required jurisdictionally

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.

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