Claims Quality Assurance

Claims Quality Assurance CorVel Corporation Join the CorVel team as a Claims Quality Assurance professional, responsible for auditing claim handling across coverage analysis, investigation, valuation, reserving, compliance, and disposition to ensure accuracy, timeliness, and adherence to industry and carrier standards. This role is available for remote or hybrid work. Essential Functions & Responsibilities Model ethical behavior and execute job responsibilities in accordance with CorVels core values, ethics, and information protection policies. Serve as technical QA lead for assigned offices or departments. Lead QA projects and coordinate senior leadership across assigned offices. Support the Claims Quality Assurance Program and EC Operations Team in developing and implementing quality improvement strategies. Lead the creation, presentation, execution, and calibration of Quality Assurance Training sessions, including integration and delivery of claims training programs. Report on pending payments, reserves, Adjuster POA/Supervisor review compliance, leakage, and other reports to assess operational performance and compliance with CorVel standards. Monitor claim financials, perform routine follow?ups for audits, identify reserve deficiencies, and correct carrier reporting deficiencies. Maintain and update real?time quality, quantity, and turnaround standards. Conduct testing on software, websites, and technical products to identify and resolve defects and processing issues. Review claim process specifications and identify appropriate parameters, functions, and data to test and validate. Conduct testing to ensure products perform according to user requirements and guidelines; report defects and recommend improvements. Submit operational QA reporting to EC Ops at specified intervals, including written corrective action plans. Participate in strategic operational calls with EC Operations and claims leadership when significant deficiencies are identified. Work with EC Operations to insert QA corrective action plans required by a carrier or client. Knowledge & Skills Excellent written and verbal communication; proven ability to serve internal and external stakeholders. Effective quantitative, analytical, and interpretive skills. Strong leadership and mentorship skills with a track record of motivating staff and achieving results. Ability to identify priorities and handle multiple responsibilities in a dynamic, fast?paced environment. Proficiency with Microsoft Office applications. Strong interpersonal, time?management, project?management, and organizational skills. Professional conduct and ability to remain poised in stressful situations. Knowledge of the entire claims administration process, including ancillary services. Ability to work independently or as part of a team while functioning as an educator. Education & Experience Bachelors Degree in Business Administration or related field, or 5+ years of equivalent experience in a complex healthcare, insurance, or third?party claim organization with significant claim management expertise. Significant industry experience and thorough understanding of CorVels proprietary systems and solutions. Certified Trainer and/or Quality Assurance experience is a plus. Pay Range Competitive market?based pay range: $68,696 $114,313, subject to adjustment based on location, experience, and qualifications. About CorVel CorVel is a national provider of risk?management solutions for workers compensation, auto, health, and disability industries. Founded in 1987, we are a certified Great Place to Work company committed to innovation, technology, and employee growth. CorVel is an Equal Opportunity Employer, drug?free workplace, and complies with ADA regulations as applicable. #J-18808-Ljbffr