MCO Claims Specialist

3 months ago

New York, United States CorVel Corporation Full time

The MCO Claims Specialist is responsible for weekly oversight of MoD performance and updates for entire claim department. The position will address all non-CorVel claims accordingly. The Claim Specialist role includes managing and retaining an assigned BoB (# of EOR and premium amount). The BoB will be comprised of lower premium employers with little to no claim activity. Retention efforts requires regular communication with EOR's to establish a relationship, provide education and serve as an industry resource. The position is result driven, and less task oriented. It requires a highly engaged consultant-like mentality servicing employers and their injured associates. The Claims Specialist serves as the primary point of contact for the EOR and their injured associates for claim related matters beginning with the Intake process. This position works closely with the Account Managers for all service related matters to strengthen the overall retention rates, as well as providing a superior customer (internal and external) experience. The Claim Specialist will manage all medical-only and non-complex claims for their assigned BoB. This position works closely with all parties to expedite a safe return to work plan which directly impacts the MCO's Quarterly Incentive Pay-MoD (revenue).

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

  • Retention of assigned BoB
  • Perform Intake and triage duties for assigned BoB
  • Maintains compliancy with capacity stats (FROI Timing, FROI TAT, and FROI Accuracy)
  • Highly engaged telephonic communication with BoB
  • Address non-CorVel claims (Intake)
  • Performs weekly MoD oversight for entire claim team
  • Some travel may be required
  • General knowledge of Ohio BWC Discount Programs and assessment deadlines and how it impacts the EOR, including basic actuarial-rate making factors (rating year private & public, snapshots….)
  • Understand the EOR's entire program and factors that influence the bottom line (Plan, TPA, BWC, AOR…)
  • Serve as a consultant to EOR
  • Serve as a liaison and resource for the EOR's vendors (i.e. TPA, BWC…)
  • Highly Effective at conflict resolution and problem-solving
  • Strong communication skills
  • Quarterly collaboration with AM's
  • Manage the entire account, not just the task or claim before you (utilize the Conduit claim/policy report with rtw data as a guide)
  • Generate Ad Hoc reports by policy and by claim, including RTW reports
  • 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

PAY RANGE:

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.

Pay Range: $15.98 - $25.69 per hour

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

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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