Claims Management Specialist

2 weeks ago


Tampa, Florida, United States CorVel Full time

Medical Claims Adjuster (Claims Specialist)

Job Category: Enterprise Comp (Claims) Requisition Number: MEDIC04030

Job Overview

CorVel is in search of a dedicated Medical Claims Adjuster to oversee straightforward medical-only claims and minor lost-time workers' compensation cases under close supervision. This role is crucial in supporting the objectives of the claims department and CorVel as a whole.

ABOUT CORVEL:

CorVel stands as a prominent provider of top-tier risk management solutions across the workers' compensation, auto, health, and disability management sectors. Established in 1987 and publicly traded since 1991, we continually invest in our workforce and technology to offer innovative and integrated solutions to our clients. With over 3,500 employees nationwide, we uphold our core values of Accountability, Commitment, Excellence, Integrity, and Teamwork (ACE-IT), fostering a stable and growth-oriented work environment with ample career advancement opportunities.

Benefits:

Our comprehensive benefits package for full-time employees includes:

  • Medical (HDHP) with Pharmacy
  • Dental and Vision Coverage
  • Long-Term Disability Insurance
  • Health Savings Account and Flexible Spending Account Options
  • Life Insurance and Accident Insurance
  • Critical Illness Insurance
  • Pre-paid Legal Insurance
  • Parking and Transit FSA Accounts
  • 401K and ROTH 401K
  • Paid Time Off

Key Responsibilities:

  • Receive and process claims, confirming policy coverage and acknowledgment.
  • Assess the validity and compensability of claims.
  • Establish reserves and authorize payments within defined limits.
  • Communicate claim status to customers, claimants, and clients.
  • Adhere to client and carrier guidelines, participating in claims reviews as necessary.
  • Assist colleagues with more complex claims as needed.
  • Perform additional projects and duties as assigned.

Required Knowledge & Skills:

  • Exceptional customer service abilities.
  • Strong written and verbal communication skills.
  • Capacity to quickly learn and understand claims practices, relevant statutes, and medical terminology.
  • Proficient in identifying, analyzing, and resolving issues.
  • Technical proficiency with MS Office, including Excel.
  • Excellent interpersonal, time management, and organizational skills.
  • Able to work independently and collaboratively within a team.

Education & Experience:

  • Bachelor's degree or equivalent combination of education and relevant experience.
  • A minimum of one year of industry experience in claims handling.
  • FL adjuster's license is preferred.


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